一例新生兒胎糞吸入綜合征合并肺動脈高壓的循證治療_《中國循證醫學雜志》

作者：

 韓樹萍 , 余章斌 , 陳玉林 , 邱玉芳 , 程佳 , 沙莉 , 吳丹青 , 李亞琴

南京醫科大學附屬南京婦幼保健院兒科（南京 210004）;

關鍵詞：

胎糞吸入綜合征新生兒持續肺動脈高壓循證治療

DOI：

10.7507/1672-2531.20090243

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目的　探討新生兒胎糞吸入綜合征合并肺動脈高壓的循證治療方法。
方法　針對患兒的臨床問題，以肺動脈高壓、新生兒、胎糞吸入綜合征、治療為主題詞和自由詞，計算機檢索 Cochrane 圖書館（2009 年第2 期）、MEDLINE（1980 ～ 2009.6）、ACP Journal Club（1991 年1 月～ 2009 年9 月）和中國期刊全文數據庫（1994 ～ 2009年6 月），查找相關的系統評價、隨機對照試驗和臨床回顧性研究等，并評價所獲證據的質量和適用性。
結果　共納入2 個系統評價、1 個Meta 分析，9 個隨機對照試驗和1 個衛生經濟學評價。所獲證據顯示：① 使用體外膜肺治療可減少患兒的病死率，但會增加治療成本；② 吸入一氧化氮可顯著升高患兒的動脈血氧分壓、減少使用體外膜肺；③ 目前尚無評價過度通氣、高頻通氣、控制性堿血癥、擴血管藥物（硫酸鎂、妥拉蘇林、前列腺素與前列環素、米力農）及肺表面活性物質治療新生兒持續肺動脈高壓臨床效果的隨機對照試驗；④ 口服西地那非可降低持續肺動脈高壓患兒的氧合指數，降低住院期間患兒的病死率。結合醫院現有條件、患兒情況及其家屬的意愿，口服西地那非治療后患兒給氧濃度降低，逐漸撤離呼吸機，一般情況可，1 個月后治愈出院。
結論　采用循證治療方法，為胎糞吸入綜合征合并肺動脈高壓的新生兒制定合理的治療方案，可有效提高治療效果，提高患兒生存率。

引用本文： 韓樹萍,余章斌,陳玉林,邱玉芳,程佳,沙莉,吳丹青,李亞琴. 一例新生兒胎糞吸入綜合征合并肺動脈高壓的循證治療. 中國循證醫學雜志, 2009, 09(12): 1339-1342. doi: 10.7507/1672-2531.20090243 復制

1.	Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am, 2009, 56(3): 579-600.
2.	Ho JJ, Rasa G. Magnesium sulfate for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev, 2007(3): CD005588.
3.	Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev, 2007(3): CD005494.
4.	Oliveira CA, Troster EJ, Pereira CR. Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(4): 145-154.
5.	Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med, 2000, 342(7): 469-474.
6.	Roberts JD Jr, Fineman JR, Morin FC, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med, 1997, 336(9): 605-610.
7.	Wessel DL, Adatia I, Van Marter LJ, et al. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics, 1997, 100(5): E7.
8.	Davidson D, Barefield ES, Kattwinkel J, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics, 1998, 101(3 Pt 1): 325-334.
9.	Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med, 2000, 28(11): 3722-3727.
10.	Sadiq HF, Mantych G, Benawra RS, et al. Inhaled nitric oxide in the treatment of moderate persistent pulmonary hypertension of the newborn: a randomized controlled, multicenter trial. J Perinatol, 2003, 23(2): 98-103.
11.	Baquero H, Soliz A, Neira F, et al. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics, 2006, 117(4): 1077-1083.
12.	Bifano EM, Hakanson DO, Hingre RV, et al. Prospective randomized controlled trial of conventional treatment or transport for ECMO in infants with persistent pulmonary hypertension (PPHN). Pediatr Res, 1992, 31(8): 196A.
13.	O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics, 1989, 84(6): 957-963.
14.	Lorch SA, Cnaan A, Barnhart K. Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn. Pediatrics, 2004, 114(2): 417-426.
15.	杜立中, 魏克倫, 孫眉月. 新生兒持續肺動脈高壓診療常規. 中華圍產醫學雜志, 2003, 6(1): 61-62.
16.	Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev, 2008(3): CD001340.
17.	Frostell C, Fratacci MD, Wain JC, et al. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation, 1991, 83(6): 2038-2047.
18.	Tolsa JF, Cotting J, Sekarski N, et al. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed, 1995, 72(3): F184-187.
19.	Abu-Osba YK, Galal O, Manasra K, et al. Treatment of severe persistent pulmonary hypertension of the newborn with magnesium sulphate. Arch Dis Child, 1992, 67(1 Spec No): 31-35.
20.	Young TE. Neofax. 19th ed. Raleigh: Acorn Publishing Inc, 2006: 136-146.

1. Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am, 2009, 56(3): 579-600.
2. Ho JJ, Rasa G. Magnesium sulfate for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev, 2007(3): CD005588.
3. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev, 2007(3): CD005494.
4. Oliveira CA, Troster EJ, Pereira CR. Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(4): 145-154.
5. Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med, 2000, 342(7): 469-474.
6. Roberts JD Jr, Fineman JR, Morin FC, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med, 1997, 336(9): 605-610.
7. Wessel DL, Adatia I, Van Marter LJ, et al. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics, 1997, 100(5): E7.
8. Davidson D, Barefield ES, Kattwinkel J, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics, 1998, 101(3 Pt 1): 325-334.
9. Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med, 2000, 28(11): 3722-3727.
10. Sadiq HF, Mantych G, Benawra RS, et al. Inhaled nitric oxide in the treatment of moderate persistent pulmonary hypertension of the newborn: a randomized controlled, multicenter trial. J Perinatol, 2003, 23(2): 98-103.
11. Baquero H, Soliz A, Neira F, et al. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics, 2006, 117(4): 1077-1083.
12. Bifano EM, Hakanson DO, Hingre RV, et al. Prospective randomized controlled trial of conventional treatment or transport for ECMO in infants with persistent pulmonary hypertension (PPHN). Pediatr Res, 1992, 31(8): 196A.
13. O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics, 1989, 84(6): 957-963.
14. Lorch SA, Cnaan A, Barnhart K. Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn. Pediatrics, 2004, 114(2): 417-426.
15. 杜立中, 魏克倫, 孫眉月. 新生兒持續肺動脈高壓診療常規. 中華圍產醫學雜志, 2003, 6(1): 61-62.
16. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev, 2008(3): CD001340.
17. Frostell C, Fratacci MD, Wain JC, et al. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation, 1991, 83(6): 2038-2047.
18. Tolsa JF, Cotting J, Sekarski N, et al. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed, 1995, 72(3): F184-187.
19. Abu-Osba YK, Galal O, Manasra K, et al. Treatment of severe persistent pulmonary hypertension of the newborn with magnesium sulphate. Arch Dis Child, 1992, 67(1 Spec No): 31-35.
20. Young TE. Neofax. 19th ed. Raleigh: Acorn Publishing Inc, 2006: 136-146.

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一例新生兒胎糞吸入綜合征合并肺動脈高壓的循證治療

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