雾化吸入硝酸甘油对先天性心脏病肺动脉高压治疗作用的研究

Nebulized nitroglycerin in treatment of congenital heart disease complicated with pulmonary hypertension

目的:探讨先天性心脏病合并肺动脉高压患者体外循环术后雾化吸入硝酸甘油对肺动脉高压的治疗效果及其机制。方法:选择术前合并中至重度肺动脉高压的先心病患者27例,应用Swan-Ganz导管动态监测术后动脉血压(AP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、肺血管阻力(PVR)、心排出量(CO)、氧合指数(PO2/FIO2)等。术后雾化吸入硝酸甘油4μg/(kg.min),分别于在吸入硝酸甘油前(基础值)、吸入后5、10、30 min和1 h记录血流动力学指标并对所得数据行统计学分析。结果:雾化吸入硝酸甘油5、103、0 min1、h后MPAP、PVR均较吸入前基础值明显下降(P<0.01),CO和PO2/FIO2则较吸入前明显增加(P<0.05),而HR、MAP、CVP、PAWP与吸入前基础值相比均无明显变化(P>0.05)。结论:雾化吸入硝酸甘油可降低肺动脉压力与肺血管阻力,增加心排出量,改善肺动脉高压患者肺循环的血流动力学,而对体循环无明显影响。

Objective： To explore the clinical effect and possible mechanism of nebulized nitroglycerin in treatment of congenital heart disease （CHD） complicated with pulmonary hypertension （PH） after open heart surgery. Methods： Twenty-seven patients suffered from CHD with moderate or severe PH were underwent open heart operation, and then they were treated with 4 μg/（kg·min） nebulized nitroglycerin. The radial artery catheterization and Swan-Ganz catheter insertion through right internal jugular vein were requisite for dynamically or persistently monitor vital signs. The hemodynamics indices, including central venous pressure（CVP）, mean arterial pressure（MAP）, mean pulmonary arterial pressure（MPAP）, pulmonary arterial wedge pressure（PAWP）, heart rate（HR）, cardiac output（CO）, oxygenation index （PO2/FIO2） and blood gas analysis were monitored before inhalation treatment （elementary value） and 5, 10, 30 and 60 minutes after inhalation treatment. All the data were statistically analyzed with matched-pairs design sample means comparison. Results： There were no significant difference between the elementary value and 5, 10, 30 or 60 minutes after inhalation in HR, MAP, CVP, and PAWP（P 〉0.05）; the MPAP and PVR both significantly decreased in 5, 10, 30 and 60 minutes after nebulized nitroglycerin treatment to the elementary value （ P 〈 0.01）, and the CO and PO2/FIO2 significantly increased after treatment（ P 〈 0.05）. Conclusion： Nebulized nitroglycerin significantly decreases both PAP and PVR and improves pulmonary hemodynamics of PH patients, however, does not influence systemic circulation.