妥拉唑林联合一氧化氮吸入治疗新生儿持续肺动脉高压的效果及其对血清PGI2和PDE3A的影响

Efficacy of tolazoline combined with inhaled nitric oxide in treatment of persistent pulmonary hypertension of newborn and its effects on serum PGI2 and PDE3A

摘要

目的 分析妥拉唑林联合一氧化氮(NO)吸入治疗新生儿持续肺动脉高压(PPHN)的效果及其对血清前列环素(PGI2)和磷酸二酯酶3A(PDE3A)的影响。方法 选取2021年7月至2024年7月于本院就诊的125例PPHN患儿作为研究对象,根据治疗方法的不同将其分为NO吸入组(n=62)、联合组(n=63),NO吸入组给予NO吸入治疗,联合组在NO吸入组基础上联合妥拉唑林治疗,采用t检验及χ²检验比较两组临床疗效、肺动脉压指标[肺动脉收缩压(PASP)、肺动脉平均压(PAMP)、肺动脉压(PAP)]、动脉血气指标[血氧饱和度(SaO₂)、动脉二氧化碳分压(PaCO₂)、动脉氧分压(PaO₂)]、血清PGI2、PDE3A、机械通气时间、氧疗时间、住院时间的差异性。结果 联合组临床总有效率(96.83%)较NO吸入组(82.26%)更高(χ²=7.116,P＜0.05)。联合组治疗后PASP、PAMP、PAP均较NO吸入组更低(t=19.010、15.204、9.343,P＜0.05)。联合组治疗后SaO₂、PaO₂均较NO吸入组更高(t=3.793、7.642,P＜0.05),联合组治疗后PaCO₂较NO吸入组更低(t=18.181,P＜0.05)。联合组治疗后血清PGI2水平较NO吸入组更高(t=3.599,P＜0.05),联合组治疗后血清PDE3A水平较NO吸入组更低(t=58.359,P＜0.05)。联合组机械通气时间、氧疗时间、住院时间均较NO吸入组更短(t=10.110、54.004、14.585,P＜0.05)。结论 妥拉唑林联合一氧化氮吸入可有效提高新生儿持续肺动脉高压治疗效率,纠正动脉血气紊乱,降低肺动脉压,上调血清PGI2表达量,下调血清PDE3A表达量,缩短氧疗及治疗时间,疗效显著。

Abstract

Objective To analyze the efficacy of tolazoline combined with inhaled nitric oxide (NO) in the treatment of persistent pulmonary hypertension of newborn (PPHN) and its effects on serum prostaglandin I2 (PGI2) and phosphodiesterase 3A (PDE3A). Methods A total of 125 newborns with PPHN treated in our hospital from July 2021 to July 2024 were enrolled and divided into the NO inhalation group (n=62) and the combination group (n=63) according to different treatment regimens. The NO inhalation group received inhaled NO therapy, while the combination group received tolazoline in addition to inhaled NO. The t test and χ² test were used to compare clinical efficacy and pulmonary artery pressure indices, including pulmonary artery systolic pressure (PASP), pulmonary artery mean pressure (PAMP), and pulmonary artery pressure (PAP), between the two groups. Arterial blood gas parameters, including oxygen saturation (SaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂), and partial pressure of oxygen in arterial blood (PaO₂), were also compared. In addition, differences in serum PGI2 and PDE3A levels, mechanical ventilation time, oxygen therapy time, and length of hospital stay were analyzed. Results The total clinical effective rate in the combination group (96.83%) was significantly higher than that in the NO inhalation group (82.26%) (χ²=7.116, P＜0.05). After treatment, PASP, PAMP, and PAP in the combination group were significantly lower than those in the NO inhalation group (t=19.010, 15.204, and 9.343, respectively, P＜0.05). After treatment, SaO₂ and PaO₂ levels in the combination group were significantly higher than those in the NO inhalation group (t=3.793 and 7.642, respectively, P＜0.05). The PaCO₂ level in the combination group after treatment was significantly lower than that in the NO inhalation group (t=18.181, P＜0.05). After treatment, serum PGI2 levels in the combination group were significantly higher than those in the NO inhalation group (t=3.599, P＜0.05). Serum PDE3A levels in the combination group after treatment were significantly lower than those in the NO inhalation group (t=58.359, P＜0.05). The mechanical ventilation time, oxygen therapy time, and length of hospital stay in the combination group were significantly shorter than those in the NO inhalation group (t=10.110, 54.004, and 14.585, respectively, P＜0.05). Conclusion Tolazoline combined with inhaled nitric oxide can effectively improve the therapeutic efficacy in newborns with persistent pulmonary hypertension, correct arterial blood gas disorders, reduce pulmonary artery pressure, upregulate serum PGI2 expression, downregulate serum PDE3A expression, and shorten oxygen therapy and treatment duration, demonstrating significant clinical benefits.

关键词

新生儿 / 持续肺动脉高压 / 妥拉唑林 / 一氧化氮 / 疗效 / 前列环素 / 磷酸二酯酶3A

Key words

neoborn / persistent pulmonary hypertension / tolazoline / nitric oxide / efficacy / prostaglandin I2 / phosphodiesterase 3A

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基金资助

二○二一年度河南省医学科学科技攻关计划项目(202102253)