Day R W, Allen E M, Witte M K
Division of Pediatric Cardiology, Primary Children's Medical Center and the University of Utah, Salt Lake City 84113-1100, USA.
Chest. 1997 Nov 5;112(5):1324-31. doi: 10.1378/chest.112.5.1324.
To determine whether 24 h of inhaled nitric oxide improves oxygenation greater than conventional therapy alone in children with acute hypoxemic respiratory failure.
Prospective, randomized, controlled study.
Twenty-six-bed pediatric ICU in a tertiary children's hospital.
Twenty-four patients with acute bilateral lung disease requiring a positive-end expiratory pressure >6 cm H2O and a fraction of inspired oxygen >0.5 for >12 h.
Twelve patients were treated with 10 ppm inhaled nitric oxide from the onset of randomization and 12 control patients were initially maintained on a regimen of conventional therapy alone. After a period of 24 h, control patients were also treated with 10 ppm inhaled nitric oxide. Hemodynamic and blood gas measurements were performed at baseline, at 1 h after randomization, and at 24-h intervals for 2 days.
Inhaled nitric oxide decreased the ratio of pulmonary to systemic vascular resistance and improved oxygenation indexes during the initial hour following randomization. However, 24 h after randomization, the oxygenation indexes of 11 surviving treated patients were not improved in comparison to baseline or the oxygenation indexes of 10 surviving control patients. Oxygenation indexes acutely improved in control patients when inhaled nitric oxide was started after 24 h of conventional therapy. Oxygenation indexes remained improved in the initial control patients after 24 h of inhaled nitric oxide.
Pulmonary vascular resistance and systemic oxygenation are acutely improved by 10 ppm inhaled nitric oxide in some children with severe lung disease. However, a sustained improvement in oxygenation may not occur during prolonged therapy. Thus, inhaled nitric oxide may have a limited therapeutic role in children with acute hypoxemic respiratory failure.
确定对于患有急性低氧性呼吸衰竭的儿童，吸入一氧化氮24小时是否比单纯常规治疗能更好地改善氧合。
前瞻性、随机、对照研究。
一家三级儿童医院设有26张床位的儿科重症监护病房。
24例患有急性双侧肺部疾病的患者，需要呼气末正压>6 cm H₂O且吸入氧分数>0.5持续超过12小时。
12例患者从随机分组开始接受10 ppm吸入一氧化氮治疗，12例对照患者最初仅接受常规治疗方案。24小时后，对照患者也接受10 ppm吸入一氧化氮治疗。在基线、随机分组后1小时以及2天内每24小时进行血流动力学和血气测量。
吸入一氧化氮在随机分组后的最初一小时内降低了肺血管阻力与体循环血管阻力的比值，并改善了氧合指数。然而，随机分组24小时后，11例存活的治疗患者的氧合指数与基线相比没有改善，也不如10例存活的对照患者的氧合指数。在常规治疗24小时后开始吸入一氧化氮时，对照患者的氧合指数急剧改善。在最初的对照患者中，吸入一氧化氮24小时后氧合指数仍保持改善。
对于一些患有严重肺部疾病的儿童，10 ppm吸入一氧化氮可急性改善肺血管阻力和全身氧合。然而，在长期治疗期间可能不会持续改善氧合。因此，吸入一氧化氮在急性低氧性呼吸衰竭儿童中的治疗作用可能有限。
