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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。
Objective To investigate the efficacy and safety of early inhalation of nitric oxide (NO) in improving premature infants with hypoxemic respiratory failure (HRF). Methods Sixty preterm infants with HRF ≤34 weeks who were admitted from 2012 to 2013 were randomly divided into NO group and control group (n = 30). Both groups received nCPAP or mechanical ventilation, and NO inhaled NO in NO group. Comparing two groups of blood gas, complications and outcome data. Results The improvement of blood gas 12 h after treatment in NO group was more obvious than that in control group (P <0.05). There was no significant difference in oxygenation state between the two groups (≥24 h) after treatment (P> 0.05). There was no significant difference between the two groups in the total time of auxiliary ventilation and the duration of oxygen therapy (P> 0.05). There was no significant difference in the incidence of bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP) and pneumothorax between the two groups (P> 0.05). However, the incidence and mortality of intraventricular hemorrhage (IVH) in NO group were lower than those in control group (7% vs 17%, 3% vs 13%, respectively; P <0.05). Conclusions Early inhalation of NO can improve the oxygenation status of premature infants and reduce the mortality of premature infants, but can not reduce the incidence of BPD and the total time of mechanical ventilation or nCPAP assisted ventilation and oxygen therapy time; inhaled NO treatment may have brain protection in preterm infants with HRF , And did not increase the incidence of clinical complications.