早期一氧化氮吸入对低氧性呼吸衰竭早产儿的疗效研究

Efficacy of inhaled nitric oxide in premature infants with hypoxic respiratory failure

摘要:

目的 探讨早期吸入一氧化氮（NO）在改善早产儿低氧性呼吸衰竭（HRF）的疗效和安全性。方法 将2012~2013 年收治的胎龄≤ 34 周患HRF 的60 例早产儿随机分为NO 组和对照组（n=30）。2 组均接受经鼻持续正压通气（nCPAP）或机械通气治疗，同时NO 组吸入NO 治疗。比较2 组血气、并发症及转归等资料。结果 NO 组在治疗后12 h 血气改善较对照组明显（P<0.05），此后（≥ 24 h）随治疗时间的变化2 组氧合状态差异无统计学意义（P>0.05）。2 组辅助通气总时间及氧疗时间的差异无统计学意义（P>0.05）。2 组支气管肺发育不良（BPD）、动脉导管开放（PDA）、坏死性小肠结肠炎（NEC）、早产儿视网膜病变（ROP）及气胸的发生率差异均无统计学意义（P>0.05）。但NO 组脑室内出血（IVH）发生率及病死率均低于对照组（分别7%vs 17%，3% vs 13%；P<0.05）。结论 早期吸入NO 能改善早产儿氧合状态，降低早产儿病死率，但不能降低BPD 发生率及机械通气或nCPAP 辅助通气总时间及氧疗时间；吸入NO 治疗可能对HRF 早产儿有脑保护作用，且未增加临床并发症发生。

Abstract:

Objective To investigate the safety and efficacy of low-concentration inhaled nitric oxide (NO) in the treatment of hypoxic respiratory failure (HRF) among premature infants. Methods Sixty premature infants (gestational age ≤34 weeks) with HRF were randomized into NO and control groups between 2012 and 2013, with 30 cases in each group. Both groups received nasal continuous positive airway pressure (nCPAP) or mechanical ventilation. NO inhalation was continued for at least 7 days or until weaning in the NO group. The general conditions, blood gas results, complications, and clinical outcomes of the two groups were analyzed. Results The NO group showed significantly more improvement in blood gas results than the control group after 12 hours of treatment (P<0.05). After that, the change in oxygenation status over time showed no significant difference between the two groups (P>0.05). There were no significant differences in total time of assisted ventilation and duration of oxygen therapy between the two groups (P>0.05). The incidence of bronchopulmonary dysplasia (BPD), patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, and pneumothorax in infants showed no significant differences between the NO and control groups (P>0.05), but the incidence of IVH and mortality were significantly lower in the NO group than in the control group (7% vs 17%, P<0.05; 3% vs 13%, P<0.05). Conclusions NO inhalation may improve oxygenation status and reduce the mortality in premature infants with HRF, but it cannot reduce the incidence of BPD and the total time of mechanical ventilation or nCPAP and duration of oxygen therapy. NO therapy may have a brain-protective effect for premature infants with HRF and does not increase clinical complications.