Luecke Caitlyn, McPherson Christopher
Neonatal Netw. 2017 May 1;36(3):160-168. doi: 10.1891/0730-0832.36.3.160.
Persistent pulmonary hypertension of the newborn (PPHN) represents a challenging condition associated with significant morbidity. A successful transition from intrauterine to extrauterine life is contingent on adequate pulmonary vasodilation. Several pathophysiologies contribute to the failure of this cascade and may result in life-threatening hypoxia and acidosis in the newborn. Management includes optimal respiratory support, adequate sedation and analgesia, and support of vascular tone and cardiac function. Pulmonary vasodilation has the potential to overcome the cycle of hypoxia and acidosis, improving outcome in these infants. Oxygen and inhaled nitric oxide represent the foundation of therapy. Tertiary pulmonary vasodilators represent a greater challenge, selecting between therapies that include prostanoids, sildenafil, and milrinone. Variable levels of evidence exist for each agent. Thorough review of available data informing efficacy and adverse effects contributes to the development of an informed approach to neonates with refractory PPHN.
新生儿持续性肺动脉高压（PPHN）是一种具有挑战性的疾病，伴有显著的发病率。从子宫内到子宫外生活的成功过渡取决于充分的肺血管舒张。几种病理生理机制导致了这一过程的失败，并可能在新生儿中导致危及生命的缺氧和酸中毒。治疗包括优化呼吸支持、充分的镇静和镇痛，以及维持血管张力和心脏功能。肺血管舒张有可能克服缺氧和酸中毒的循环，改善这些婴儿的预后。氧气和吸入一氧化氮是治疗的基础。三级肺血管扩张剂带来了更大的挑战，需要在包括前列腺素、西地那非和米力农在内的治疗方法之间进行选择。每种药物的证据水平各不相同。全面审查有关疗效和不良反应的现有数据，有助于为患有难治性PPHN的新生儿制定明智的治疗方法。
