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证据为基础的指南:新生儿持续肺动脉高压的急性稳定化和管理。

Evidence-Based Guidelines for Acute Stabilization and Management of Neonates with Persistent Pulmonary Hypertension of the Newborn.

机构信息

Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.

Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio.

出版信息

Am J Perinatol. 2023 Oct;40(14):1495-1508. doi: 10.1055/a-1711-0778. Epub 2021 Dec 1.

DOI:10.1055/a-1711-0778
PMID:34852367
Abstract

Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN. KEY POINTS: · PPHN is associated with several unique diagnoses; the associated pathophysiology is different for each unique diagnosis.. · PPHN is a challenging, dynamic, and labile process for which optimal care requires frequent reassessment.. · Key management goals are adequate tissue oxygen delivery, avoiding harm..

摘要

新生儿持续性肺动脉高压,简称 PPHN,是一种具有挑战性的病症,与高发病率和死亡率相关。其管理因复杂的病理生理学和有限的新生儿特定循证医学文献而变得复杂,导致缺乏针对这些患者的通用当代临床指南。为了解决这一需求,并为我们新生儿重症监护病房中这一具有挑战性的人群提供一致的高质量临床护理,我们寻求制定一份全面的临床指南,用于急性稳定和管理患有 PPHN 的新生儿。我们利用跨学科专业知识,并进行广泛的文献搜索以指导最佳实践,为急性 PPHN 的床边管理提供了一种易于理解、实用且具有临床相关性的方法。

关键点

· PPHN 与几种独特的诊断有关;每种独特诊断的相关病理生理学不同。

· PPHN 是一个具有挑战性、动态和不稳定的过程,需要频繁重新评估以实现最佳护理。

· 关键管理目标是提供足够的组织氧输送,避免伤害。

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The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn.在新生儿持续性肺动脉高压的治疗中使用补充性氢化可的松。
J Perinatol. 2021 Apr;41(4):794-800. doi: 10.1038/s41372-021-00943-9. Epub 2021 Feb 15.
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Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review.足月新生儿持续肺动脉高压伴系统性低血压的管理:病例图片复习。
Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):446-455. doi: 10.1136/archdischild-2020-319705. Epub 2021 Jan 21.
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Efficacy of Milrinone Plus Sildenafil in the Treatment of Neonates with Persistent Pulmonary Hypertension in Resource-Limited Settings: Results of a Randomized, Double-Blind Trial.
米力农联合西地那非治疗资源有限地区持续性肺动脉高压新生儿的疗效:一项随机、双盲试验的结果。
Paediatr Drugs. 2020 Dec;22(6):685-693. doi: 10.1007/s40272-020-00412-4.
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Persistent Pulmonary Hypertension of the Newborn: Pathophysiological Mechanisms and Novel Therapeutic Approaches.新生儿持续性肺动脉高压:病理生理机制与新型治疗方法
Front Pediatr. 2020 Jul 24;8:342. doi: 10.3389/fped.2020.00342. eCollection 2020.
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Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension.氢化可的松可改善足月持续性肺动脉高压患儿的氧合指数和收缩压。
Clin Med Insights Pediatr. 2019 Nov 21;13:1179556519888918. doi: 10.1177/1179556519888918. eCollection 2019.
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The Use of Cardiotonic Drugs in Neonates.新生儿心搏药物的应用。
Clin Perinatol. 2019 Jun;46(2):273-290. doi: 10.1016/j.clp.2019.02.010. Epub 2019 Mar 30.
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The use of milrinone in neonates with persistent pulmonary hypertension of the newborn - a randomised controlled trial pilot study (MINT 1): study protocol and review of literature.米力农用于新生儿持续性肺动脉高压的随机对照试验初步研究(MINT 1):研究方案及文献综述
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Pediatr Crit Care Med. 2018 Sep;19(9S Suppl 1):S137-S148. doi: 10.1097/PCC.0000000000001603.
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Int J Cardiol. 2018 Aug 1;264:153-157. doi: 10.1016/j.ijcard.2018.03.067. Epub 2018 Mar 15.
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