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目的 评价一氧化氮(NO)吸入和硫酸镁(MgSO_4)静脉滴注治疗新生儿严重肺动脉高压的疗效。方法 34例急性低氧性肺动脉高压新生儿分别采用NO吸入(iNO组,25例)或硫酸镁静脉滴注(MgSO_4组,11例)治疗,利用三尖瓣返流或动脉导管分流,采用多普勒超声心动图在治疗前后测定肺动脉收缩压(SPAP),并计算肺动脉/体循环收缩压之比(SPAP/SBP),评价其疗效。结果 在治疗后30～120min、18～24h和治疗结束时,iNO组的SPAP(mm Hg)由治疗前的59±9分别降至43±9、40±14和25±8(与治疗前比较,均P<0.01),SPAP/SBP由0.93±0.17分别下降至0.69±0.13、0.65±0.24和0.36±0.15(与治疗前比较,均P<0.01),SBP无显著改变;MgSO_4组的SPAP(mm Hg)则由治疗前的62±9分别下降至54±6、44±8和35±21(与治疗前比较,均P<0.01),SPAP/SBP由0.93±0.12分别降至0.82±0.29(与NO吸入组比较,P<0.01)、0.65±0.28和0.54±0.35(与治疗前比较,均P<0.05),SBP在治疗后30～120min显著降低,在治疗后18～24h恢复正常。结论 低浓度外源性NO吸入和MgSO_4静脉滴注均可有效治疗新生儿肺动脉高压,其中NO吸入起效更迅速,且具有高度肺血管选择性。
Objective To evaluate the efficacy of nitric oxide (NO) inhalation and intravenous infusion of magnesium sulfate (MgSO 4) in the treatment of severe pulmonary hypertension in newborns. Methods Thirty-four neonates with acute hypoxic pulmonary hypertension were treated with NO inhalation (iNO group, n = 25) or intravenous infusion of magnesium sulfate (n = 10). Tricuspid regurgitation or arterial catheter shunting was used. Pulmonary artery systolic pressure (SPAP) was measured before and after treatment, and pulmonary artery / systolic blood pressure (SPAP / SBP) ratio was calculated to evaluate the therapeutic effect. Results The SPAP (mm Hg) in iNO group decreased from 59 ± 9 before treatment to 43 ± 9, 40 ± 14 and 25 ± 8 respectively at 30 ~ 120min, 18 ~ 24h and after treatment (All P <0.01). The SPAP / SBP decreased from 0.93 ± 0.17 to 0.69 ± 0.13, 0.65 ± 0.24 and 0.36 ± 0.15 respectively (all P <0.01 before treatment) mm Hg) decreased from 62 ± 9 before treatment to 54 ± 6, 44 ± 8 and 35 ± 21 respectively (all P <0.01 compared with before treatment), and SPAP / SBP decreased from 0.93 ± 0.12 to 0.82 ± 0.29 (P <0.01 compared with NO inhalation group), 0.65 ± 0.28 and 0.54 ± 0.35 (all P <0.05 compared with before treatment), SBP decreased significantly after 30 ~ 120min and returned to normal after 18 ~ 24h. Conclusions Both low concentration exogenous NO inhalation and MgSO 4 intravenous drip can effectively treat pulmonary hypertension in neonates. NO inhalation is more effective and has high pulmonary vascular selectivity.