新生儿持续性肺动脉高压吸入一氧化氮治疗的撤机策略
Weaning strategy with inhaled nitric oxide treatment in persistent pulmonary hypertension of the newborn.
作者信息
Aly H, Sahni R, Wung J T
机构信息
Department of Pediatrics, Columbia University, New York, NY 10032, USA.
出版信息
Arch Dis Child Fetal Neonatal Ed. 1997 Mar;76(2):F118-22. doi: 10.1136/fn.76.2.f118.
AIM
To determine if infants who had become dependent on inhaled nitric oxide treatment could be successfully weaned off it if FIO2 was increased briefly during withdrawal.
METHODS
Sixteen infants admitted for conditions associated with increased pulmonary vascular resistance responded well to inhaled nitric oxide treatment with a significant increase in PaO2 (maximum inhaled nitric oxide given 25 ppm). Weaning from inhaled nitric oxide in 5 ppm decrements was initiated once the FIO2 requirement was less than 0.5. When patients were stable on 5 ppm of inhaled nitric oxide, the gas was then discontinued. If a patient showed inhaled nitric oxide dependence-that is, oxygen saturation fell by more than 10% or below 85%-inhaled nitric oxide was reinstated at 5 ppm and the patient allowed to stabilise for 30 minutes. At this time, FIO2 was increased by 0.40 and weaning from inhaled nitric oxide was attempted again.
RESULTS
Nine infants were successfully weaned on the first attempt. The seven infants who failed the initial trial were all successfully weaned following the increase in FIO2. After successful weaning, FIO2 was returned to the pre-weaning level in mean 148(SD 51) minutes and inhaled nitric oxide was never reinstated.
CONCLUSION
Infants showing inhaled nitric oxide dependency can be successfully weaned by increasing FIO2 transiently.
目的
确定对于已依赖吸入一氧化氮治疗的婴儿，在撤药期间短暂提高吸入氧分数（FIO2）是否能成功撤掉该治疗。
方法
16名因肺血管阻力增加相关病症入院的婴儿对吸入一氧化氮治疗反应良好，动脉血氧分压（PaO2）显著升高（最大吸入一氧化氮浓度为25 ppm）。一旦FIO2需求低于0.5，便开始以每次降低5 ppm的幅度撤掉吸入一氧化氮。当患者在吸入5 ppm一氧化氮时情况稳定，然后停用该气体。如果患者表现出对吸入一氧化氮的依赖，即血氧饱和度下降超过10%或降至85%以下，则重新给予5 ppm的吸入一氧化氮，并让患者稳定30分钟。此时，将FIO2提高0.40，然后再次尝试撤掉吸入一氧化氮。
结果
9名婴儿首次尝试即成功撤药。最初试验失败的7名婴儿在提高FIO2后均成功撤药。成功撤药后，FIO2平均在148（标准差51）分钟后恢复到撤药前水平，且再也没有重新使用吸入一氧化氮。
结论
对吸入一氧化氮有依赖的婴儿可通过短暂提高FIO2成功撤药。
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