| Objective:The purpose of this study is to review and analyze the clinical application of inhaling nitric oxide（iNO）in the treatment of neonatal persistent pulmonary hypertension（PPHN）in the First Affiliated Hospital of Jinan University,Shenzhen Bao’an District Maternal and Child Health Hospital and Foshan Chancheng District Central Hospital from January 1,2016 to December 31,2019.It can provide more experience and reference for clinical application.Methods:The subjects are hospitalized children diagnosed as PPHN in the First Affiliated Hospital of Jinan University,Shenzhen Bao’an District Maternal and Child Health Hospital and Foshan Chancheng District Central Hospital from January 1,2016 to December 31,2019.According to whether inhaled nitric oxide,it was divided into iNO group and non-iNO group.Through the electronic medical record system to consult the medical record data,the relevant content and indicators are recorded and statistically analyzed.The basic data,drug treatment,therapeutic effect,respiratory support,hospital stay,common adverse reactions,complications and deaths of the two groups were compared.Results:1.A total of 82 children in 3 hospitals met the inclusion criteria,including 42 cases in iNO group and 40 cases in non-iNO group.Children in the two groups were stratified according to the primary diseases of secondary PPHN.MAS,RDS,intrauterine infectious pneumonia,septicemia and pulmonary damage caused by asphyxia accounted for 21.9%（18 cases）,19.5%（16 cases）,24.4%（20 cases）,18.3%（15 cases）and 15.9%（13 cases）,respectively,and the difference of other baseline characteristics was statistically no significant（P>0.05）.2.In the iNO group,11.9%（5 cases）needed to apply PS twice due to their disease conditions,while in the non-iNO group,30.0%（12 cases）needed to apply PS twice,with statistically significant difference（P<0.05）.Normal saline was expanded in 69.0%（29cases）of the iNO group and 87.5%（35 cases）of the non-iNO group,with statistically significant differences（P<0.05）.3.Compared with the non-iNO group,the response rates of the iNO group befo-re treatment,within 12h,24h and 48h were 0%vs 0%,54.7%vs 30.0%,69.0%vs 47.5%,88.1%vs 70.0%,respectively;Fi O2were 0.80±0.15 vs 0.81±0.14,0.60±0.14 vs 0.67±0.12,0.42±0.13 vs 0.50±0.16,0.37±0.17 vs 0.45±0.19;Pa O2/Fi O2（mm Hg）were 51.7±2.9 vs 51.4±3.1,103.2±33.1 vs 82.3±39.2,166.6±68.9 vs 126.8±78.7,218.6±114.9 vs161.3±120.6;OI were 25.0±4.5 vs 25.3±4.3,16.0±3.1 vs 17.5±3.7,14.8±2.9 vs 16.3±3.8,13.9±2.3 vs 15.4±2.9;PAP（mm Hg）were 62.2±8.7 vs 62.5±9.1,43.9±11.9 vs 49.7±9.1,32.1±8.4 vs 37.3±9.8,25.3±6.4 vs 28.5±7.7,with statistically significant differ-ences（all P<0.05）.4.The number of days of invasive assisted ventilation,non-invasive assisted ventilation,and oxygen therapy in the iNO group was all lower than that in the non-iNO group,which were 5.5±2.2 days vs 6.9±3.9 days,2.5±1.1 days vs 3.5±1.5 days,and 3.4±0.5days vs 4.3±1.0 days,with statistically significant differences（all P<0.05）;the average length of stay in iNO group and non-iNO group were 19.6±5.6 days and 22.0±3.7 days respectively,the difference was statistically significant（P<0.05）.5.Hypotension occurred in 50.0%（21 cases）of the iNO group,shock occurred in28.6%（12 cases）of the iNO group,BPD occurred in 7.1%（3 cases）of the iNO group;and hypotension occurred in 72.5%（29 cases）of the non-iNO group,shock occurred in50.0%（20 cases）of the non-iNO group,BPD occurred in 22.5%（9 cases）of the non-iNO group,the difference was statistically significant（P<0.05）.Me Hb（%）≥2%didn’t occur in both groups,PLT<100×109/L（16.7%vs 12.5%,or 7 vs 5 cases）,obviously abnormal blood coagulation（11.9%vs 17.5%,or 5 vs 7 cases）,intracranial hemorrhage（16.7%vs 12.5%,or7 vs 5 cases）,pulmonary hemorrhage（14.3%vs 12.5%,or 6 vs 5 cases）,gastrointestinal hemorrhage（9.5%vs 7.5%,or 4 vs 3 cases）,subcutaneous hemorrhage（4.8%vs 7.5%,or 2vs 3 cases）,with no statistically significant differences（all P>0.05）.6.In the iNO group and non-iNO group,14.3%（6 cases）and 12.5%（5 cases）of children died,7.1%and 7.5%（3 cases,respectively）of children died because of PPHN secondary to sepsis,2.4%and 2.5%（1 case,respectively）of children died because of PPHN secondary to asphyxia pulmonary damage,4.8%（2 cases）and 2.5%（1 case）of children died because of PPHN secondary to MAS,none of children died because of PPHN secondary to intrauterine pneumonia and RDS in both groups.There was all no significant difference between the two groups（P>0.05）.Conclusions:The efficacy of iNO in the treatment of PPHN is better than that of alone drugs（sildenafil and milrinone）,which can improve oxygenation,reduce pulmonary artery pressure,reduce the need for correcting hypovolemia with normal saline and the secondary use of PS,reduce the incidence of hypotension,shock and BPD,shorten the time of respiratory support,and reduce length of stay. |
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