Clinic And Experimental Work On Mechanical Ventilation In Treatment Of Persistent Pulmonary Hypertension Of Newborn

Aim: To evaluate the value of mechanical ventilation including conventional mechanical ventilation (CMV) and high frequency oscillatory ventilation (HFOV) compared with vasodilator only on treatment of persistent pulmonary hypertension of newborn (PPHN). Method: Retrospective study on 78 cases of PPHN who were divided into three groups based on different treatments: 18 cases were in group A treated by vasodilator (dopamine, tolazoline, phentolamine or magnesium sulfate) only, 26 cases were in group B and treated by vasodilator plus CMV, 34 cases were in group C and treated by vasodilator plus HFOV. In group B and C there were some cases treated by pulmonary surfactant (PS) or inhaled nitric oxide (iNO) also. Several indexes including clinic outcomes, blood-gas analysis, radiologic and echocardiographic findings and vasoactive peptides as endothelin-1 (ET-1), atrial natriuretic peptide (ANP) and calcitonin-gene related peptide (CGRP) were observed. Results: There were more recovered cases in group B (92.3%) and group C (91.2%) than in group A (77.8%) (P<0.05), especially in those treated combined with PS (95.7%) or iNO(97.3%). Serial blood-gas analysis showed that cases in group B or C had better oxygenation indexes including pH, PaO2, PaCO2, PA-aO2, BE and OI than those in group A(P<0.05, P<0.01). Moreover, HFOV showed better oxygenation compared to CMV. Infants treated by mechanical ventilation combined with PS or iNO therapy had more improvements in oxygenation indexes. Vasoactive peptides ET-1, ANP and CGRP had quicker recovered tendencies in group B and group C than in group A (P<0.05,P<0.01). Conclusion: In this retrospective study we demonstrated that mechanical ventilation especially HFOV combined with vasodilators had a more value functions in treatment of PPHN. Mechanical ventilation combined with PS or iNO therapy maybe the best choice in treatment of PPHN. Vasoactive peptide ET-1, ANP and CGRP could play important role in pathophysiologic developmental mechanism in PPHN and be a valuable index in judgement of outcome of PPHN clinically.