早期多次气管内滴入肺表面活性物质联合吸入一氧化氮治疗新生儿持续肺动脉高压的临床疗效

HU Xiao-long; ZHANG Xiao-hua; JIN Li-zhu

doi:10.3969/j.issn.1009-8933.2025.2.lnxxgbzz-e202502005

摘要：Background Persistent pulmonary hypertension(PPHN)of the newborn is one of the major contributors to neonatal mortality.Current conventional treatments for PPHN primarily encompass mechanical ventilation,inhaled nitric oxide(iNO),sildenafil,and magnesium sulfate.In confirmed cases of neonatal respiratory distress syndrome,pulmonary surfactant(PS)can be considered as a potential treatment option;However,the optimal dosage and ad-ministration frequency of PS remain subjects of ongoing debate.This study aimed to assess the efficacy of early re-peated endotracheal PS administration combined with iNO therapy in the management of newborns with PPHN.Methods Twenty-three neonates with PPHN received iNO alongside foundational treatments,including anti-in-fection therapy,mechanical ventilation,acidosis correction,and blood pressure stabilization.The observation group(n=13)received endotracheal instillation of PS three times,with each administration spaced six hours apart;The control group(n=10)received endotracheal instillation of PS once.Parameters compared included blood gas indi-ces,oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(PA-aDO2),pulmonary artery sys-tolic pressure(PAP),and N-terminal pro-brain natriuretic peptide(NT-pro-BNP).Mechanical ventilation duration,oxygen therapy time,hospitalization length,and survival outcomes were recorded and compared between groups.Results The blood gas parameters,OI,and PA-aDO2 showed no significant differences between the two groups of children before treatment(P>0.05).By 24-hour post-treatment,both groups exhibited significant increases in par-tial pressure of oxygen(PaO2)and potential of hydrogen(PH)levels,alongside significant decreases in lactate,par-tial pressure of carbon dioxide(PaCO2),OI,and PA-aDO2,with statistically significant differences(P<0.05).By 48-hour post-treatment,the observation group demonstrated significantly better improvements in blood gas parame-ters,OI,and PA-aDO2 compared to the control group,and these differences were statistically significant(P<0.05).There was no statistically significant difference in PAP and NT-pro-BNP levels between the two groups before treat-ment(P>0.05).After treatment,both groups showed significant decreases in PAP and NT-pro-BNP levels(P<0.05),with a more pronounced reduction observed in the observation group(P<0.05).The observation group had signifi-cantly shorter durations of mechanical ventilation and oxygen therapy compared to the control group,with statisti-cally significant differences(P<0.05).Additionally,the observation group exhibited a shorter total hospital stay and a lower mortality rate than the control group,though these differences were not statistically significant(P>0.05).Conclusions Early consecutive multiple doses of PS combined with iNO,compared to a single dose,better im-proves respiratory function indices,maintains stability,reduces pulmonary artery pressure,enhances cardiac func-tion,shortens ventilator dependency,and increases cure rates in PPHN neonates.This approach is particularly suit-able for severe PPHN cases,especially those with underlying pulmonary conditions.[S Chin J Cardiol 2025;26(2):98-106]