Karamanoukian H L, Glick P L, Zayek M, Steinhorn R H, Zwass M S, Fineman J R, Morin F C
Department of Surgery, State University of New York at Buffalo.
Pediatrics. 1994 Nov;94(5):715-8.
We determined whether inhaled nitric oxide (NO) could improve systemic oxygenation in human neonates with hypoplastic lungs.
A multicenter nonrandomized investigation was performed to study the efficacy of short-term NO inhalation. Inhaled NO was administered at 80 ppm to nine neonates without evidence of structural cardiac disease by echocardiography. Lung hypoplasia was due to congenital diaphragmatic hernia (CDH) in eight patients and to oligohydramnios in one patient. A total of 15 trials of NO inhalation were performed in these nine patients. Eight trials in seven patients were performed before extracorporeal membrane oxygenation ((ECMO); one patient had two trials) and seven trials were performed in five patients after decannulation from ECMO (two patients had two trials each).
NO inhalation before ECMO did not change postductal PaO2 (42 +/- 3 mmHg vs 42 +/- 4 mmHg), oxygen saturation (SpO2; 89% vs 88%) or oxygenation index (31 +/- 4 cm H2O/torr vs 31 +/- 4 cm H2O/torr) for the group. All patients required ECMO support, which lasted from 5 to 17 days (mean 9). After decannulation from ECMO, NO inhalation increased postductal PaO2 from a median of 56 mm Hg (range 41 to 94) to a median of 113 mm Hg (range 77 to 326), P < .05. It decreased the oxygenation index from a median of 23 cm H2O/torr (range 11 to 7) to a median of 11 cm H2O/torr (range 4 to 21), P < .05. It increased SpO2 from 91% to 96% (P < .05) and pH from 7.48 +/- .03 to 7.50 +/- .03.
In our patients with hypoplastic lungs, inhaled NO was effective only after ECMO. This could be due to maturational changes such as activating the endogenous surfactant system. Inhaled NO may be effective in neonates with hypoplastic lungs who have recurrent episodes of pulmonary hypertension after ECMO, even if they were previously unresponsive.
我们确定吸入一氧化氮（NO）是否能改善肺发育不全的人类新生儿的全身氧合。
进行了一项多中心非随机研究以探讨短期吸入NO的疗效。通过超声心动图对9例无结构性心脏病证据的新生儿给予80 ppm的吸入NO。8例患者的肺发育不全是由于先天性膈疝（CDH），1例患者是由于羊水过少。这9例患者共进行了15次NO吸入试验。7例患者中的8次试验在体外膜肺氧合（ECMO）之前进行（1例患者进行了2次试验），5例患者中的7次试验在从ECMO撤管后进行（2例患者各进行了2次试验）。
ECMO之前吸入NO并未改变该组患者导管后动脉血氧分压（PaO2）（42±3 mmHg对42±4 mmHg）、氧饱和度（SpO2；89%对88%）或氧合指数（31±4 cm H2O/torr对31±4 cm H2O/torr）。所有患者均需要ECMO支持，持续时间为5至17天（平均9天）。从ECMO撤管后，吸入NO使导管后PaO2从中位数56 mmHg（范围41至94）增至中位数113 mmHg（范围77至326），P<0.05。它使氧合指数从中位数23 cm H2O/torr（范围11至7）降至中位数11 cm H2O/torr（范围4至21），P<0.05。它使SpO2从91%增至96%（P<0.05），pH从7.48±0.03增至7.50±0.03。
在我们的肺发育不全患者中，吸入NO仅在ECMO之后才有效。这可能归因于诸如激活内源性表面活性剂系统等成熟变化。吸入NO可能对ECMO后反复发生肺动脉高压的肺发育不全新生儿有效，即使他们先前无反应。
