吸入性一氧化氮治疗早产儿与足月儿新生儿肺动脉高压的疗效分析

Analysis of the Efficacy of Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn: A Comparison between Premature and Term Infants

摘要: 目的：对比分析不同胎龄新生儿肺动脉高压(PPHN)患儿使用吸入性一氧化氮(iNO)治疗的效果差异。方法：回顾性分析2017年1月至2023年12月这期间安徽省儿童医院新生儿科收治的218例接受iNO治疗的新生儿临床资料，按胎龄分为早产儿与足月儿组，比较两组患儿的一般资料、iNO的治疗参数与治疗效果、治疗前后各项指标(动脉氧分压PaO₂、二氧化碳分压PaCO₂、酸碱度pH、平均气道压MAP、吸入氧气浓度FiO₂)的变化及最终的转归情况。结果：共纳入符合条件的PPHN新生儿共172例，其中早产儿组58例，足月儿组114例。早产儿组出生体重较低，肺表面活性物质使用概率更高，治疗前后的吸氧浓度都较足月儿更高，使用iNO治疗早产儿的有效率为48%，足月儿为57%，足月儿有效率更高，但两组之间差异无统计学意义(P > 0.05)。在使用6小时iNO治疗后，两组的PaO₂、PaCO₂都较治疗前明显改善(P < 0.05)，但两组之间的差异无统计学意义(P > 0.05)，而足月儿组MAP改善较早产儿组更为显著(P < 0.05)。足月儿组住院时间较短，使用呼吸机天数与吸氧天数较短(P < 0.05)，两组最终结局方面，其中足月儿组存活率为65%，高于早产儿组的50%，但两者之间差异无统计学意义(P > 0.05)。结论：不同胎龄的治疗下，iNO对不同胎龄的PPHN新生儿均有较好的治疗效果，但足月儿的氧合指标及动脉血气改善较早产儿更好。

Abstract: Objective: This paper aims to compare and analyze the differences in the efficacy of inhaled nitric oxide (iNO) treatment in persistent pulmonary hypertension of the newborn (PPHN) of different gestational ages. Method: A retrospective analysis was conducted on the clinical data of 218 newborns treated with iNO in the neonatology department of Anhui Children’s Hospital from January 2017 to December 2023. The newborns were divided into premature and full-term infant groups according to gestational age, and their general information, iNO treatment parameters and treatment effects, changes in various indicators (arterial oxygen pressure PaO₂, carbon dioxide pressure PaCO₂, pH, mean airway pressure MAP, inhaled oxygen concentration FiO₂) before and after treatment, and final outcomes were compared between the two groups. Result: A total of 172 eligible PPHN newborns were included, including 58 premature infants and 114 full-term infants. The premature infant group had lower birth weight, higher probability of pulmonary surfactant use, and higher oxygen concentration before and after treatment compared to full-term infants. The effective rate of iNO treatment for premature infants was 48%, while that for full-term infants was 57%. The effective rate for full-term infants was higher, but there was no statistically significant difference between the two groups (P > 0.05). After 6 hours of iNO treatment, both groups showed significant improvement in PaO₂ and PaCO₂ compared to before treatment (P < 0.05), but the difference between the two groups was not statistically significant (P > 0.05). The MAP improvement in the full-term infant group was more significant than that in the premature infant group (P < 0.05). The hospitalization time of full-term infants was shorter, and the days of using ventilators and oxygen inhalation were shorter (P < 0.05). In terms of the final outcomes of the two groups, the survival rate of full-term infants was 65%, which was higher than that of premature infants (50%), but the difference between the two groups was not statistically significant (P > 0.05). Conclusion: iNO has good therapeutic effects on PPHN newborns of different gestational ages, but the improvement of oxygenation indicators and arterial blood gas in full-term infants is better than that in premature infants.