吸入一氧化氮治疗先天性心脏病术后肺动脉高压

Inhalation of nitric oxide in the treatment of postoperative pulmonary hypertension in children with congenital heart disease

目的评价吸入一氧化氮(NO)在左向右分流性先天性心脏病(先心病)术后严重肺动脉高压的治疗效果。方法81例先天性心脏病患儿术后予以吸入NO治疗,治疗指征:肺/体动脉收缩压之比(Pp/Ps)>0.5,氧合指数(PaO2/FiO2)<150mmHg,传统降肺动脉压治疗无效。初始吸入浓度为20×10-6vol/vol,根据血气及血流动力学情况进一步调整,不超过45×10-6vol/vol,同时监测二氧化氮(NO2)浓度及高铁血红蛋白浓度。结果81例吸入NO治疗后肺动脉压力明显下降,从(54.0±15.8)mmHg降至(45.7±12.8)mmHg(P<0.01),而体动脉压力无明显变化,同时PaO2/FiO2明显改善,从100.6±40.1升至135.8±29.7(P<0.01)。监测NO2浓度<1×10-6vol/vol,高铁血红蛋白浓度<2%。未发现明显出血及其他不良反应。结论吸入NO治疗可以安全有效地降低肺动脉压力,提高氧合指数,从而改善先心病合并肺动脉高压的预后。

Objective To assess the therapeutic efficacy of inhaled nitric oxide(iNO) in the cases with congenital heart defects who developed critical pulmonary hypertension postoperatively. Methods 81 patients were enrolled in the iNO treatment from January 1997 to December 2004. Indication for iNO therapy was as following: ratio of pulmonary to systemic systolic arterial pressure(Pp/ Ps)> 0. 5, ratio of arterial oxygen tension to fraction of inspired oxygen(PaO2/FiO2) <150 mmHg, and failure in administration of conventional pulmonary vasodilator. Initial iNO was started at 20 x 10-6 vol/vol ,and adjusted according to blood gas and hemodynamic changes, maximal at 45×10-6vol/ vol. Results In the 81 patients during iNO treatment, Pp decreased from(54.0±15.8) to (45.7±12. 8) mmHg(P<0. 01) without significant change in Ps, whereas PaO2/FiO2 increased from 100.6±40.1 to 135. 8±29. 7(P<0. 01). Inhaled nitrogen dioxide was less than 1×10-6vol/ vol and serum methemoglobin was less than 2%.No hemorrhage and other adverse effects were observed. Conclusions iNO treatment improved pulmonary hemodynamics and blood oxygenation in postoperative critical pulmonary hypertension without adverse effects.