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吸入一氧化氮治疗胎粪吸入综合征时新生儿需要体外膜式人工氧合法治疗模式的指征

世界核心医学期刊文摘（儿科学分册） 2005年第12期1卷 49-50页

作者： friedlich p. Noori S. Stein J. 王经纬 Division of Neonatology Department of Pediatrics Childrens Hospital Los Angeles Los Angeles CA 90027 United States

As the use of inhaled nitric oxide (iNO) resulted in a decline in the need for extracorp.real membrane oxygenation (ECMO) in neonates with hyp.xic resp.ratory failure, iNO has become an accep.ed treatment modality even in non-ECMO centers. However, because not all neonates resp.nd to iNO, the timely identification and transfer of nonresp.nders to an ECMO center are imp.rtant. Abstract: The objective of this study was to identify the risk factors p.edictive of the need of ECMO in neonates with hyp.xic resp.ratory failure after the first 6 hours of iNO treatment in an ECMO center. Methods and p.tient p.p.lation: Forty-nine p.tients with hyp.xic resp.ratory failure transferred for iNO therap. and p.tential ECMO during a 2- year p.riod were identified in this retrosp.ctive study. None of the p.tients had received iNO before admission. Strict clinical guidelines were used to standardize lung inflation, cardiovascular sup.ort, and iNO administration and weaning and to define treatment failure. The relationship.between treatment failure (ie, the need for ECMO) and a set of susp.cted risk factors after 6 hours of iNO administration was examined by logistic regression analysis. Results: Twenty-two neonates resp.nded to iNO(non-ECMO group.whereas 27 neonates failed and met ECMO criteria (ECMO group.. There was no difference between the 2 group. in demograp.ic data, ventilatory sup.ort, air leak syndrome at 6 hours of iNO treatment, and survival to discharge. However, the dose and duration of iNO therap. were p.edictive of the need for ECMO with an adjusted odds ratio of 1.12 (95% CI, 1.01- 1.25; p.= .04) and 0.45 (95% CI, 0.27- 0.65; p.= .0002), resp.ctively. Conclusions: By the end of the first 6 hours of iNO treatment and under the sp.cific conditions established by the use of the clinical guidelines, the dose and the duration of iNO administration were p.edictive of the p.obability for the need of ECMO in this p.tient p.p.lation. Thus, one can establish a center-sp.cific p

关键词：胎粪吸入综合征低氧性呼吸衰竭膜式肺通气临床指南存活情况对数回归气体渗人口学资料持续时间

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