Roberts J D, Fineman J R, Morin F C, Shaul P W, Rimar S, Schreiber M D, Polin R A, Zwass M S, Zayek M M, Gross I, Heymann M A, Zapol W M
Department of Anesthesia, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
N Engl J Med. 1997 Feb 27;336(9):605-10. doi: 10.1056/NEJM199702273360902.
Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance in newborns. We studied whether inhaled nitric oxide decreases severe hypoxemia in infants with persistent pulmonary hypertension.
In a prospective, multicenter study, 58 full-term infants with severe hypoxemia and persistent pulmonary hypertension were randomly assigned to breathe either a control gas (nitrogen) or nitric oxide (80 parts per million), mixed with oxygen from a ventilator. If oxygenation increased after 20 minutes and systemic blood pressure did not decrease, the treatment was considered successful and was continued at lower concentrations. Otherwise, it was discontinued and alternative therapies, including extracorporeal membrane oxygenation, were used.
Inhaled nitric oxide successfully doubled systemic oxygenation in 16 of 30 infants (53 percent), whereas conventional therapy without inhaled nitric oxide increased oxygenation in only 2 of 28 infants (7 percent). Long-term therapy with inhaled nitric oxide sustained systemic oxygenation in 75 percent of the infants who had initial improvement. Extracorporeal membrane oxygenation was required in 71 percent of the control group and 40 percent of the nitric oxide group (P=0.02). The number of deaths was similar in the two groups. Inhaled nitric oxide did not cause systemic hypotension or increase methemoglobin levels.
Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.
新生儿持续性肺动脉高压由于肺血管阻力增加和脱氧血液右向左分流导致体循环动脉低氧血症。吸入一氧化氮可降低新生儿的肺血管阻力。我们研究了吸入一氧化氮是否能降低持续性肺动脉高压婴儿的严重低氧血症。
在一项前瞻性多中心研究中，58名患有严重低氧血症和持续性肺动脉高压的足月儿被随机分配，分别呼吸来自呼吸机的与氧气混合的对照气体（氮气）或一氧化氮（百万分之80）。如果20分钟后氧合增加且体循环血压未降低，则认为治疗成功，并以较低浓度继续治疗。否则，停止治疗并使用包括体外膜肺氧合在内的替代疗法。
30名婴儿中有16名（53%）吸入一氧化氮后体循环氧合成功翻倍，而未吸入一氧化氮的传统疗法仅使28名婴儿中的2名（7%）氧合增加。在最初有改善的婴儿中，75%接受吸入一氧化氮长期治疗后体循环氧合得以维持。对照组71%的婴儿和一氧化氮组40%的婴儿需要进行体外膜肺氧合（P=0.02）。两组的死亡人数相似。吸入一氧化氮未引起体循环低血压或使高铁血红蛋白水平升高。
吸入一氧化氮可改善持续性肺动脉高压婴儿的体循环氧合，并可能减少对更具侵入性治疗的需求。
