对吸入一氧化氮的初始氧合反应可预测先天性膈疝预后改善。
Initial oxygenation response to inhaled nitric oxide predicts improved outcome in congenital diaphragmatic hernia.
作者信息
Tiryaki Sibel, Ozcan Coskun, Erdener Ata
机构信息
Hacettepe University, Ankara, Turkey,
出版信息
Drugs R D. 2014 Dec;14(4):215-9. doi: 10.1007/s40268-014-0063-7.
BACKGROUND
Pulmonary hypertension (PH) is the most important complication of congenital diaphragmatic hernia (CDH) and still has a high mortality rate. The aim of this study was to evaluate the effectiveness of inhaled nitric oxide therapy in PH due to CDH.
METHODS
Hospital records of children who had undergone inhaled nitric oxide therapy for PH due to CDH between June 2009 and December 2011 were reviewed.
RESULTS
Twenty-nine patients had a diagnosis of CDH at the time of study, and eight of these patients underwent nitric oxide therapy because of failure of conventional ventilation techniques, which was successful in five of these patients. Patients who had a good overall outcome of nitric oxide therapy experienced rapid improvement (pretreatment, mean PaO2 = 44.8 mmHg; after the first hour of therapy, mean PaO2 = 96.8 mmHg), whereas patients with no response did not have a similar course (pretreatment, PaO2 = 37 mmHg; after the first hour, PaO2 = 54.6 mmHg).
CONCLUSION
Inhaled nitric oxide therapy seems to increase survival in PH due to CDH. No predictive parameters to orient patient selection could be identified; however, the early response seemed to predict the overall outcome. Good results in our series were attributed to routine use of sildenafil and dopamine, along with the nitric oxide inhalation.
背景
肺动脉高压（PH）是先天性膈疝（CDH）最重要的并发症，死亡率仍然很高。本研究的目的是评估吸入一氧化氮治疗CDH所致PH的有效性。
方法
回顾了2009年6月至2011年12月期间因CDH所致PH接受吸入一氧化氮治疗的儿童的医院记录。
结果
29例患者在研究时被诊断为CDH，其中8例因传统通气技术失败而接受一氧化氮治疗，5例治疗成功。一氧化氮治疗总体效果良好的患者病情迅速改善（治疗前，平均动脉血氧分压=44.8mmHg；治疗第一小时后，平均动脉血氧分压=96.8mmHg），而无反应的患者则没有类似的病程（治疗前，动脉血氧分压=37mmHg；第一小时后，动脉血氧分压=54.6mmHg）。
结论
吸入一氧化氮治疗似乎可提高CDH所致PH患者的生存率。未发现指导患者选择的预测参数；然而，早期反应似乎可预测总体结果。我们系列研究中的良好结果归因于常规使用西地那非和多巴胺以及吸入一氧化氮。
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