双肺移植围手术期一氧化氮吸入治疗——附5例报告

Perioperative Inhaled Nitric Oxide Therapy for Bilateral Lung Transplantation, with Five Cases Report

目的:探索一氧化氮吸入疗法在双肺移植围手术期的临床应用。方法:5例序贯式双肺移植病例围手术期予一氧化氮吸入治疗(iNO),其中男性4例,女性1例,年龄37-56岁;一氧化氮(NO)吸入与监测装置采用Siements Servo 300A (Siemins-Elema AB,Sweden)呼吸机,或Aeronox(Pulmonox,Canada)NO吸入与监测仪。在麻醉开始后开始iNO,开始剂量20 ppm,待供体肺吻合完成并开始开放血液循环时将剂量增至40-60 ppm。结果:5例均顺利渡过围手术期。术后机械通气时间为36-79 h,平均48．8±6．3 h。iNO治疗时间为86-160 h,平均102．6±12．2 h。术后48 h病人肺动脉压达到高峰,氧合(PaO2／FiO2)降低,并随着综合治疗逐步好转。iNO治疗过程中与治疗结束后病人与工作人员未发现可疑的不良反应。结论:本组病人在iNO中未发生意外事件,iNO治疗有效,在术后早期未发生明显低氧血症或肺动脉高压。

Objective：Clinical implementation of perioperative inhaled nitric oxide therapy （iNO） in bilateral lung transplantation. Methods： Perioperative iNO was carried out in five sequential bilateral lung transplantations patients, Four males and one females. Age ranging from 37 to 56 years. Nitric oxide delivery and monitoring were implemented with Siemens Servo 300A and Pulmonox Aeronox devices, iNO started after anesthetic tracheal intubation. Starting dose of iNO was 20 ppm, and rose to 40-60 ppm after allograft lung circulatory perfusion released. Results： Five patients passed though perioperative period successfully without any complication. Post operative mechanical ventilation duration ranged from 36 to 79 hrs （mean 48.8 ± 6.3 hrs）. Duration of iNO was 86-160 hrs （mean 102.6 ± 12.2 hrs）. Pulmonary artery pressure reached peak in 48 hrs postoperatively. PaO2/FiO2 reached lowest point postoperatively. Pulmonary artery pressure and PaO2/FiO2 improved by comprehensive management. No adverse event was found in patients and caregivers during and after iNO therapy. Conclusion： iNO therapy is effective in our bilateral lung transplantation. No significant hypoxia or pulmonary hypertension noted in early postoperative period of our sequential bilateral lung transplantation.