Darlow B, Kempthorne P, Knight D, Wong M
Department of Paediatrics, Christchurch School of Medicine.
N Z Med J. 1998 Dec 11;111(1079):474-7.
To audit the use of inhaled nitric oxide for the treatment of persistent pulmonary hypertension of the newborn in New Zealand neonatal intensive care units.
Prospective data collection on all infants treated with inhaled nitric oxide in neonatal intensive care units in the 20-month period from first use to December 1995. Data included perinatal factors, principal diagnosis, echocardiogram results, ventilation details and response to nitric oxide, adverse reactions and outcome.
Twenty-eight infants received nitric oxide in three centres, all bar one being 36 weeks or more gestation. Overall survival was 68%. Thirteen infants (46%) responded to nitric oxide treatment, 12 (92%) surviving. Seven (47%) of non-responders survived. Infants with primary pulmonary hypertension or meconium aspiration syndrome had 90% survival and more often responded to nitric oxide than infants with congenital diaphragmatic hernia (40% survival) or pulmonary hypoplasia (no survivors). No serious complications of treatment were recorded.
Inhalational nitric oxide was not universally successful treatment for pulmonary hypertension of the newborn but was likely to have been life-saving in a proportion of cases. Future studies may allow better case selection. Ongoing audit of this new treatment is warranted.
审核新西兰新生儿重症监护病房中吸入一氧化氮治疗新生儿持续性肺动脉高压的使用情况。
前瞻性收集在1995年首次使用至12月的20个月期间，新生儿重症监护病房中所有接受吸入一氧化氮治疗的婴儿的数据。数据包括围产期因素、主要诊断、超声心动图结果、通气细节以及对一氧化氮的反应、不良反应和结局。
三个中心的28名婴儿接受了一氧化氮治疗，除一名婴儿外，其余婴儿的孕周均为36周或以上。总体存活率为68%。13名婴儿（46%）对一氧化氮治疗有反应，其中12名（92%）存活。7名无反应者（47%）存活。原发性肺动脉高压或胎粪吸入综合征婴儿的存活率为90%，对一氧化氮有反应的情况比先天性膈疝婴儿（40%存活）或肺发育不全婴儿（无存活者）更常见。未记录到严重的治疗并发症。
吸入一氧化氮并非对新生儿肺动脉高压的普遍有效治疗方法，但在一部分病例中可能挽救了生命。未来的研究可能会实现更好的病例选择。对这种新治疗方法进行持续审核是有必要的。
