Journal of Developmental Medicine(Electronic Version)  2018, Vol. 6 Issue (3): 166-171 DOI: 10.3969/j.issn.2095-5340.2018.03.007 |
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| Clinical study of the triple therapy in treatment of neonatal respiratory distress syndrome combined with persistent pulmonary hypertension |
| LIN Xin-zhu LIU Long-bin TANG Li-xia ZHU Yao CHEN Chao
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| 1. Neonatal Department, Maternal and Child Health Care Hospital, Xiamen, Fujian 361000, China; 2. Neonatal Department, Children's Hospital of Fudan University, Shanghai 201102, China) |
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Abstract 【Abstract】 Objective To explore the clinical effectiveness of the triple therapy of high-frequency oscillation ventilation (HFOV), pulmonary surfactant (PS) and inhaled nitric oxide (iNO) in infants with respiratory distress syndrome (RDS) combined with persistent pulmonary hypertension (PPHN). Methods From January 1st 2010 to June 30th 2017, 31 infants diagnosed as RDS complicated with PPHN were admitted to Neonatal Department of Maternal and Child Health Care Hospital of Xiamen and all of the cases were treated by the triple therapy. The clinical characteristics and outcomes were analyzed. The pHvalue, oxygenation index (OI), pulmonary arterial pressure (PAP), and PaO2/FiO2 (P/F) were compared before and after treatment for 24 and 48 hours. T test, Chi-square test and repeated measure of ANOVA were used for statistical analysis. Results The mean gestational age of 31 infants was (36.2±2.9) weeks, 14 cases were late preterm infants (45.2%, 14/31), 11 cases were full-term infants (35.5%, 11/31). 24 cases were delivered by cesarean section (77.4%, 24/31), among which 21 cases were selective cesarean section (67.7%, 21/31). The mean OI value, PAP value and P/F ratio of the 31 cases were 36±16, (57±11) mmHg and 53±27 respectively before the triple therapy. There were no signi?cant differences of the outcomes in varying degrees of OI values, PAP value and P/F ratio (P ﹥ 0.05). After 24 and 48 hours of triple therapy, the values of pH, PaO2 and PaCO2 were signi?cantly improved, and the values of OI and PAP were signi?cantly decreased and the P/F ratios were signi?cantly increased compared with those before the triple therapy (P ﹤ 0.05). The average length of hospital stay was (22±11) days. 24 cases were cured (77.4%,
24/31), 5 cases were improved(16.1%，5/31) and 2 cases died (6.5%, 2/31). The cure and improvement
rates of the triple therapy were 83.3% (5/6), 80.0% (4/5) and 94.1% (16/17) respectively in the critically ill infants with OI value ≥ 40, PAP value ﹥ 70 mmHg and P/F ratio ﹤ 50. Conclusions The triple therapy has a synergistic effect to improve oxygenation and increase success rate in the treatment of infants with RDS complicated by PPHN, and can reduce the need of extracorporeal membrane oxygenation for the critically ill infants.
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Received: 15 January 2018
Published: 20 August 2018
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