Perez-Benavides F, Boynton B R, Desai N S, Goldthorn J F
Department of Pediatrics, University of Kentucky Medical Center, Lexington.
J Perinatol. 1993 May-Jun;13(3):181-5.
Persistent pulmonary hypertension of the newborn (PPHN) is a challenge for the neonatologist and a common indication for treatment with extracorporeal membrane oxygenation (ECMO) when medical management fails. We observed 132 neonates born between January 1985 and December 1988 with the diagnosis of persistent pulmonary hypertension of the newborn: 73 (55%) met the Bartlett criteria for treatment with ECMO with 80% predicted mortality; 21 (29%) deteriorated despite conventional medical treatment, were thought to be dying, and were sent for ECMO. Among the 52 patients who were medically treated 40 (77%) survived, a marked difference compared with a predicted 20% survival. All ECMO-treated neonates survived. Although conventionally treated infants showed a trend toward less dependence on supplemental oxygen at > 28 days of life, this study failed to detect a significant difference between those two groups. We conclude that mortality was lower for ECMO-treated infants than for those who were medically treated (0 of 21 vs 12 of 52, p < 0.05); mortality for infants with persistent pulmonary hypertension of the newborn who met Bartlett's criteria and were medically treated was lower than published data; and there was no significant difference in oxygen dependence at > 28 days between the survivors who received ECMO and those who received medical therapy.
新生儿持续肺动脉高压（PPHN）对新生儿科医生来说是一项挑战，当药物治疗失败时，它是体外膜肺氧合（ECMO）治疗的常见适应症。我们观察了1985年1月至1988年12月间出生的132例诊断为新生儿持续肺动脉高压的新生儿：73例（55%）符合Bartlett的ECMO治疗标准，预计死亡率为80%；21例（29%）尽管接受了传统药物治疗仍病情恶化，被认为濒临死亡，被送去接受ECMO治疗。在接受药物治疗的52例患者中，40例（77%）存活，与预计20%的存活率相比有显著差异。所有接受ECMO治疗的新生儿均存活。尽管接受传统治疗的婴儿在出生28天后对补充氧气的依赖程度有降低的趋势，但本研究未能检测到两组之间的显著差异。我们得出结论，接受ECMO治疗的婴儿死亡率低于接受药物治疗的婴儿（21例中的0例 vs 52例中的12例，p < 0.05）；符合Bartlett标准并接受药物治疗的新生儿持续肺动脉高压婴儿的死亡率低于已发表的数据；接受ECMO治疗的幸存者和接受药物治疗的幸存者在出生28天后的氧气依赖程度没有显著差异。
