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目的探讨前列地尔联合高频振荡通气(HFOV)治疗新生儿持续肺动脉高压(PPHN)的临床疗效。方法选取潍坊医学院附属潍坊市人民医院新生儿科2012年1月至2014年2月收治的PPHN患儿,随机分为观察组和对照组,观察组在综合治疗的基础上加用前列地尔联合HFOV,对照组在综合治疗的基础上加用HFOV。监测并比较两组患儿血气分析、肺动脉收缩压(PASP)、呼吸机使用时间、治疗有效率及不良反应等。结果观察组和对照组各入选19例,两组治疗前血气分析及PASP差异无统计学意义,治疗后各项指标均有所改善。治疗后3天观察组p H、Pa O2、Sa O2高于对照组[p H:(7.43±0.06)比(7.31±0.10),Pa O2:(87.3±9.7)mm Hg比(58.4±8.5)mm Hg,Sa O2:(97.8±7.6)%比(71.5±6.3)%],Pa CO2、PASP低于对照组[Pa CO2:(34.1±7.7)mm Hg比(45.3±4.0)mm Hg,PASP:(27.6±5.0)mm Hg比(40.5±4.2)mm Hg],差异有统计学意义(P<0.05)。观察组呼吸机使用时间短于对照组[(74.5±2.8)h比(129.3±5.6)h],治疗有效率高于对照组(89.5%比52.6%),差异有统计学意义(P<0.05);两组气胸发生率差异无统计学意义(0比5.3%,P>0.05)。结论前列地尔联合HFOV治疗PPHN患儿,可迅速改善氧合,纠正低氧血症,降低PASP,减少呼吸机上机时间,疗效确切,不良反应少,值得临床推广。
Objective To investigate the clinical efficacy of alprostadil combined with high frequency oscillatory ventilation (HFOV) in the treatment of neonatal persistent pulmonary hypertension (PPHN). Methods Weifang People’s Hospital Affiliated to Weifang Medical College Nephrology January 2012 to February 2014 were admitted to the PPHN children were randomly divided into observation group and control group, the observation group on the basis of comprehensive treatment with alprostadil HFOV, the control group on the basis of comprehensive treatment with HFOV. Blood gas analysis, pulmonary artery systolic pressure (PASP), ventilator use time, treatment efficiency and adverse reactions were monitored and compared between the two groups. Results The observation group and the control group were enrolled in each of the 19 cases. There was no significant difference in blood gas analysis and PASP between the two groups before treatment. After treatment, all the indexes improved. The values of p H, Pa O2 and Sa O2 in the observation group were higher than those in the control group 3 days after the treatment [p H: (7.43 ± 0.06) vs (7.31 ± 0.10), Pa O2: (87.3 ± 9.7) mm Hg vs (58.4 ± 8.5) mmHg, Sa O2: (97.8 ± 7.6)% (71.5 ± 6.3)%], PaCO 2 and PASP were lower than those in the control group [PaCO 2: (34.1 ± 7.7) mm Hg vs : (27.6 ± 5.0) mm Hg ratio (40.5 ± 4.2) mm Hg], the difference was statistically significant (P <0.05). The use of ventilator in the observation group was shorter than that in the control group [(74.5 ± 2.8) h vs (129.3 ± 5.6) h], and the effective rate of treatment was higher in the observation group than in the control group (89.5% vs 52.6%, P <0.05 ). There was no significant difference in the incidence of pneumothorax between the two groups (0 vs 5.3%, P> 0.05). Conclusions Alprostadil combined with HFOV in children with PPHN can rapidly improve oxygenation, correct hypoxemia, reduce PASP, reduce the time of ventilator, and has definite curative effect and few adverse reactions. It is worthy of clinical promotion.