朱良梅?孔少云?李晓春

【摘要】目的 探討新生儿持续肺动脉高压死亡的常见危险因素。方法 回顾性分析50例新生儿持续肺动脉高压伴呼吸衰竭患儿的临床资料，50例患儿均需机械通气且均接受了一氧化氮吸入治疗。根据预后将其分为治愈组（38例）和死亡组（12例），收集患儿母亲、患儿的一般资料以及患儿肺动脉压、肺表面活性物质使用情况、呼吸机模式、治疗前后的动脉血气分析及并发气胸等资料，统计分析各因素与患儿死亡的关系。结果 死亡组高频呼吸机使用比例低于治愈组（P < 0.05）。死亡组合并气胸的比例高于治愈组（P < 0.05）;死亡组血pH值及PaO2在一氧化氮吸入治疗后低于治愈组（P均< 0.05）。多因素Logistic回归分析提示，机械通气联合一氧化氮吸入治疗后动脉血PaO2值为影响新生儿持续肺动脉高压预后的独立危险因素（OR = 0.715，95%CI 0.525 ～ 0.973，P < 0.05）。结论 尽早使用高频呼吸机并联合一氧化氮吸入治疗，及时纠正低氧血症，维持正常动脉血PaO2可提高新生儿持续肺动脉高压的救治成功率，改善患儿预后。

【关键词】机械通气;高频振荡通气;一氧化氮吸入; 新生儿持续性肺动脉高压;

低氧血症;预后

Analysis of risk factors of death in neonates with persistent pulmonary hypertension Zhu Liangmei， Kong Shaoyun， Li Xiaochun. Department of Neonatology， Anqing Municipal Hospital Affiliated to Anhui Medical University， Anqing 246003， China

Corresponding author， Li Xiaochun， E-mail： Vlxc2002@ aliyun. com

【Abstract】Objective To explore the risk factors of death in neonates diagnosed with persistent pulmonary hypertension. Methods Clinical data of 50 neonates with persistent pulmonary hypertension complicated with respiratory failure were retrospectively analyzed. All neonates received mechanical oscillatory ventilation combined with nitric oxide （NO） inhalation. According to clinical prognosis， they were divided into the healing group （n = 38） and death group （n = 12）. The general data of mothers and neonates， pulmonary artery pressure， pulmonary surfactant use， ventilator mode， arterial blood gas analysis before and after treatment and pneumothorax were collected. The relationship between various factors and neonatal death was statistically analyzed. Results The proportion of high-frequency oscillatory ventilator use in the death group was significantly lower than that in the healing group （P < 0.05）. The proportion of pneumothorax in the death group was remarkably higher than that in the healing group （P < 0.05）. After NO inhalation treatment， the pH value and PaO2 in the death group were significantly lower than those in the healing group （both P < 0.05）. Multivariate Logistic regression analysis showed that PaO2 value of the arterial blood was an independent risk factor for clinical prognosis after mechanical oscillatory ventilation combined with NO treatment （OR = 0.715， 95%CI 0.525 - 0.973， P < 0.05）. Conclusions Early use of high-frequency oscillatory ventilation combined with NO inhalation， timely management of hypoxemia and maintenance of normal arterial blood PaO2 can improve the success rate of treatment and improve the clinical prognosis of the affected neonates.

【Key words】Mechanical ventilation;High-frequency oscillatory ventilation;Inhalation of nitric oxide;

Persistent pulmonary hypertension of the newborn;Hypoxemia;Prognosis

新生儿持续肺动脉高压（PPHN）是指各种因素导致新生儿出生后肺血管阻力不能有效下降，肺动脉压力持续性增高，致心脏在动脉导管或心房水平出现右向左分流，临床上出现紫绀，表现为严重的难以纠正的低氧血症等[1]。PPHN是新生儿时期的一种严重疾病，据统计，在存活的新生儿中其发病率约2‰[2]。目前临床上治疗PPHN的措施有机械通气、使用肺表面活性物质（PS）、吸入一氧化氮、使用血管活性药物等，但PPHN仍对新生儿的生命造成严重威胁[3]。在本文中，笔者纳入50例PPHN患儿作为研究对象，该组患儿均需机械通气，且均接受了一氧化氮吸入治疗，回顾性分析其临床资料以探讨影响其不同预后的可能因素，为进一步提高PPHN救治成功率提供参考。

对象与方法

一、研究对象

选取我院新生儿科2014年1月至2019年12月收治的50例接受机械通气联合一氧化氮吸入治疗的PPHN患儿为研究对象，根据不同的预后将其分为死亡组及治愈组，死亡组12例、治愈组38例，病死率24.0%。……