Muller W, Kachel W, Lasch P, Varnholt V, Konig S A
Kinderklinik, Neonatal ICU, Theodor-Kutzer-Ufer, Mannheim, Germany.
Intensive Care Med. 1996 Jan;22(1):71-6. doi: 10.1007/BF01728335.
Inhaled nitric oxide (NO) is thought to provide a noninvasive therapeutic alternative to extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).
Since January 1993, we have studied inhalation of NO in PPHN patients meeting the ECMO criteria of our institution. We focused on the questions of whether or not the need for ECMO could be obviated and whether differences could be found between NO responders and nonresponders.
NO gas was delivered via conventional IPPV ventilation in incrementally increasing concentrations from 20 to 80 ppm.
NO therapy was attempted in ten ECMO candidates with clinical and echocardiographical evidence of PPHN (mean OI 51.9, SD 10.4).
At various NO levels (30-60 ppm), five patients showed a significant increase in mean PaO2 (range 32.9-85.9 mmHg). Improvement was transient in three patients (6-10 h) and prolonged in two others (54-80 h); in the latter cases, ECMO was avoided. Five patients did not respond at all to treatment. Responders and nonresponders differed in their mean respiratory tidal volume (8.9 vs 4.18 ml/kg, P <0.05).
In our study, inhalation of NO obviated the necessity of ECMO therapy in only two out of ten PPHN patients. Thus, we would discourage any overoptimistic expectations about the effectiveness of NO therapy in PPHN until larger clinical trials have been performed.
吸入一氧化氮（NO）被认为是在治疗新生儿持续性肺动脉高压（PPHN）时提供一种替代体外膜肺氧合（ECMO）的非侵入性治疗方法。
自1993年1月以来，我们对符合本机构ECMO标准的PPHN患者进行了吸入NO的研究。我们关注的问题是是否可以避免使用ECMO，以及在NO反应者和无反应者之间是否能发现差异。
通过传统的间歇正压通气（IPPV）以20至80 ppm的浓度递增输送NO气体。
对10名有PPHN临床和超声心动图证据的ECMO候选患者尝试了NO治疗（平均氧合指数51.9，标准差10.4）。
在不同的NO水平（30 - 60 ppm）下，5名患者的平均动脉血氧分压（PaO2）显著升高（范围为32.9 - 85.9 mmHg）。3名患者的改善是短暂的（6 - 10小时），另外2名患者的改善持续时间较长（54 - 80小时）；在后两种情况下，避免了使用ECMO。5名患者对治疗完全无反应。反应者和无反应者的平均呼吸潮气量不同（8.9 vs 4.18 ml/kg，P <0.05）。
在我们的研究中，10名PPHN患者中只有2名通过吸入NO避免了ECMO治疗。因此，在进行更大规模的临床试验之前，我们不鼓励对NO治疗PPHN的有效性抱有任何过于乐观的期望。
