Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn: Four-Year Experience in a Single Medical Center

使用一氧化氮吸入治療新生兒持續性肺高壓症：一醫學中心四年之經驗

蘇百弘(Bai-Horng Su) ； 林宗文(Tsung-Wen Lin) ； 林鴻志(Hung-Chih Lin) ； 蔡輔仁(Fuu-Jen Tsai) ； 彭慶添(Ching-Tien Peng)

《Acta Paediatrica Taiwanica》 43卷5期 (2002/10) Pp. 259-264

https://doi.org/10.7097/APT.200210.0259

摘要

以前瞻性研究收集自1997年7月至2001年6月患有持續肺高壓症之48個新生兒，來探討一氧化氮(Nitric oxide,NO)吸入療法之效果及其離脫方法。當患兒之血氧濃度持續改善30分鐘後，開始降低NO之吸入濃度，每10分鍾降低5ppm直到達到5ppm，然後維持2～3小時。在降低NO的過程中，如果SpO2下降超過10%或下降至低於85%，則NO恢復到上一個濃度且維持2～3小時。而在這個NO的維持濃度時，在患兒可以忍受的情況下每10分鍾調降FiO2 10%，最高吸氣壓也逐漸調降，但要避免血氧濃度激烈下降。經過2～3小時後，再來嚐試降低NO之濃度。當患兒的SpO2在NO 5ppm時能維持正常穩定2～3小時，則NO可以中止。此時可以調升FiO2 10～20%。如果NO中止後5分鐘內，SpO2下降超過10%或下降到低於85%，則再度回復到使用NO 5ppm。經過2～3小時患兒穩定時，再來嚐試中止NO治療。本研究之結果，34個患兒(70.8%)存活，40個患兒(83.3%)(包括34個存活及6個死亡)對NO吸入療法有良好反應。NO平均有效濃度爲37(5～80)ppm，NO平均使用時間爲43(6～153)小時。我們的結果顯示NO吸入療法重症新生兒持續性肺高壓症是一種有效的救命方法，但患兒之最後預後不只決定於對NO是否有良好反應，而且取決於其合併症之情形。我們的NO离脫方法，可以縮短使用NO的時間，和以前的一個報告比較是43對87小時。在重症新生兒持續性肺高壓症，早期使用NO吸入療法可能是縮短NO使用時間的重要因素。

關鍵字

新生兒持續性肺高壓症 ； 一氧化氮吸入療法 ； 離脫方法

並列摘要

Forty-eight infants with persistent pulmonary hypertension of the newborn (PPHN) from July, 1997 to June, 2001 were enrolled for a prospectively study to determine the role of inhaled nitric oxide (NO) treatment and to determine an appropriate weaning strategy of NO. The initial dose of NO was started at 10ppm for 10 minutes. If the infant's symptoms did not improve, we used a rapid dose ladder schedule for increasing the dose of NO to 20, 40 and 80ppm every 10 minutes until we achieved the desired response. When oxygenation improved for 30 minutes, NO was decreased by 5ppm every 10 minutes until reaching 5ppm which was maintained for 2-3 hours. During the NO weaning period, if the SpO2 decreased by 10% or fell below 85%, the NO was increased to the previous higher dose and maintained this lowest effective dose for 2-3 hours. During this period, FiO2 was decreased by 10% every 10 minutes and peak inspiratory pressure was decreased gradually as the infant tolerable to avoid a decrease in saturation; we then tried to repeat the weaning procedure of NO. Inhaled NO was discontinued at 5ppm if the infants were stable for 2-3 hours, and at the same time FiO2 was permitted to raise 10-20%. If SpO2 decreased by 10% or fell below 85% within 5 minutes, NO was reinstated at 5ppm. A second attempt at weaning NO was made 2-3 hours later when the infants were stable. Thirty-four infants (70.8%) survived. Forty infants (83.3%), including 34 who survived and 6 who died, had good responses to inhaled NO. The mean effective NO concentration was 37(5-80)ppm. The mean duration of inhaled NO treatment was 43(6-153) hours. This study has demonstrated that inhaled NO is an effective rescue treatment for infants with severe PPHN, but the final outcome of infants depends not only on the response to inhaled NO but also on the associated complications. Using our weaning strategy, we shortened the duration of inhaled NO treatment as compared with a previous study (43 vs. 87 hours). Beginning inhaled NO therapy early in severe PPHN may be an important factor in shortening the duration of inhaled NO therapy. Further controlled trials of this weaning strategy are warranted.

並列關鍵字

persistent pulmonary hypertension of the newborn ； inhaled nitric oxide ； weaning