Vakrilova L, Radulova P, Hitrova St, Slancheva B
Akush Ginekol (Sofiia). 2014;53(4):50-8.
Pulmonary hypertension of the newborn is a clinical syndrome with diverse etiology in which the transition from fetal circulation with high pulmonary vascular resistance to postnatal circulation with low pulmonary vascular resistance failed. The persistence of high pulmonary vascular pressure leads to right-left shunts and marked cyanosis. Despite of the advances in neonatology, the treatment of some forms of PPHN is often difficult and mortality rate remains high. In infants with PPHN appropriate interventions are critical to reverse hypoxemia, improve pulmonary and systemic perfusion and preserve end-organ function. Our understanding for management of PPHN has evaluated over decades. This review summarizes the current strategies for treatment of pulmonary hypertension of the newborn: general care, cardiovascular support, the advantages and limitations of different ventilatory strategies, oxygen therapy, extracorporal membrane oxygenation, and the evidence-based inhaled nitric oxide therapy. The balance between pulmonary vasoconstrictor and vasodilator mediators plays an important role for pulmonary vascular resistance. Recent studies are designed to develop evidence-based therapies for regulation of pulmonary vascular tone, safe medications for selective pulmonary vasodilatation effective for treatment of PPHN and other forms of pulmonary hypertension in the neonatal intensive care unit.
新生儿肺动脉高压是一种病因多样的临床综合征，其特征为未能从具有高肺血管阻力的胎儿循环成功过渡到具有低肺血管阻力的产后循环。高肺血管压力持续存在会导致右向左分流和明显的紫绀。尽管新生儿学取得了进展，但某些形式的新生儿持续性肺动脉高压（PPHN）的治疗往往困难，死亡率仍然很高。对于患有PPHN的婴儿，适当的干预措施对于逆转低氧血症、改善肺和全身灌注以及保护终末器官功能至关重要。我们对PPHN管理的认识在几十年间不断发展。本综述总结了新生儿肺动脉高压的当前治疗策略：一般护理、心血管支持、不同通气策略的优缺点、氧疗、体外膜肺氧合以及循证吸入一氧化氮疗法。肺血管收缩剂和血管扩张剂介质之间的平衡对肺血管阻力起着重要作用。最近的研究旨在开发循证疗法以调节肺血管张力、寻找用于选择性肺血管扩张的安全药物，这些药物对新生儿重症监护病房中PPHN和其他形式的肺动脉高压治疗有效。
