Goldman A P, Tasker R C, Haworth S G, Sigston P E, Macrae D J
Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
Pediatrics. 1996 Oct;98(4 Pt 1):706-13.
To determine the clinical role of inhaled nitric oxide (iNO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).
Prospective open observational clinical study.
A regional cardiac and pediatric intensive care unit.
Twenty-five consecutive near-term neonates (> 35 weeks gestation) with severe PPHN (oxygenation index [OI] > 25) were given a trial of iNO of 20 ppm for 20 minutes. Neonates who showed a greater than 20% improvement in PaO2 as well as a decrease in the OI to below 40 were defined as responders and continued on this therapy.
Four patterns of response emerged to the iNO therapy: Pattern 1 neonates (n = 2) did not respond to the initial trial of iNO-one survived. Pattern 2 neonates (n = 9) responded to the initial trial of iNO, but failed to sustain this response over 36 hours, as defined by a rise in the OI to > 40. Six survived, five with extracorporeal membrane oxygenation. Pattern 3 neonates (n = 11) responded to the initial trial of iNO, sustained this response, and were successfully weaned from iNO within 5 days--all survived to discharge. Pattern 4 neonates (n = 3) responded to the initial trial of iNO, but developed a sustained dependence on iNO for 3 to 6 weeks. All three died and lung histology revealed severe pulmonary hypoplasia and dysplasia. These neonates (pattern 4) not only required iNO for a longer period of time than did the sustained responders (pattern 3), but they required significantly higher doses of iNO during their first 5 days of iNO therapy.
Early responses to iNO may not be sustained. Neonates with pulmonary hypoplasia and dysplasia may have a decreased sensitivity and differing time course of response to iNO when compared with patients who have PPHN in fully developed lungs.
确定吸入一氧化氮（iNO）在新生儿持续性肺动脉高压（PPHN）治疗中的临床作用。
前瞻性开放性观察性临床研究。
某地区心脏及儿科重症监护病房。
对25例连续入选的近足月（孕周>35周）重度PPHN（氧合指数[OI]>25）新生儿给予20 ppm的iNO治疗20分钟。PaO₂改善超过20%且OI降至40以下的新生儿被定义为反应者，并继续接受该治疗。
iNO治疗出现四种反应模式：模式1新生儿（n = 2）对iNO初始试验无反应，1例存活。模式2新生儿（n = 9）对iNO初始试验有反应，但未能在36小时内维持该反应，即OI升至>40。6例存活，5例接受体外膜肺氧合治疗。模式3新生儿（n = 11）对iNO初始试验有反应，维持该反应，并在5天内成功停用iNO，全部存活至出院。模式4新生儿（n = 3）对iNO初始试验有反应，但对iNO产生持续依赖3至6周。3例均死亡，肺组织学检查显示严重肺发育不全和发育异常。这些新生儿（模式4）不仅比持续反应者（模式3）需要更长时间的iNO治疗，而且在iNO治疗的前5天需要显著更高剂量的iNO。
对iNO的早期反应可能无法持续。与肺发育完全的PPHN患儿相比，肺发育不全和发育异常的新生儿对iNO的敏感性可能降低，反应时程也不同。
