心脏外科肺动脉高压患者围手术期一氧化氮吸入治疗

Perioperative Inhaled Nitric Oxide Therapy for Open Heart Surgery Patients

目的：探索一氧化氮吸入治疗方法（iNO）对合并肺动脉高压的心脏外科围手术期病人的有效性与安全性。 方法：应用Sevro 3300A与Pulmonox Aeronox释放与监测仪器，对合并肺动脉高压并且临床一般治疗效果不理想的27例成人和1例小儿心脏外科围手术期病人进行iNO的治疗。iNO有效标准为治疗开始后1小时内AP/PAP改善20%以上，或PaO2/FiO2改善20%以上。iNO治疗开始后1.5小时治疗无效者终止iNO治疗。 结果：成人病例iNO有效率为77.8%（21/27），iNO治疗持续时间为12-96小时（32.6±10.3小时），1例小儿房间痛缺损合并中度肺动脉高压患儿在房间隔缺损修补术后肺动高压加重合并严重的低氧血症（PaO2/FiO2=40mmHg/100%）,经iNO等综合治疗，效果明显，4天后脱呼吸机，治疗中与治疗后病人与工作人员未发现不良事件。 结论：iNO疗法对心脏外科合并肺动脉高压围术期病情加重者治疗有效，很值得进一步临床探索。

Objective： TO investigate effectiveness and safety of perieperative inhaled nitnc oxide therapy （iNO） in open heart surgery patients with pulmonary hypertension. Method： Servo 300A and Pulmonox Aeronox were used for nitric oxide delivery and monitoring. INO was used penoperatively in 27 adult and 1 pediatdc open heart surgery pabents with pulmonary hypertension which was not effective relieved by conventional treatment. Criteria for iNO responsiveness is： AP/PAP or PaO2/FiO2 improved more than 20% within 1 hour INO therapy was discontinued if it was not responsive within 1.5 hr. Result： Responsive rate in these adult patients is 77 8% , 2 1/27 ） .Duration of iNO therapy was 12-96 （32.6±10.3） hours One 4-year-old atrial septal detect child with median severity of pulmonary artery hypertension got deterioration of pulmonary hypertension with sedous hypoxemia （ PaO2FiO2= 40mmHg /100% ） post operatively INO therapy was very responsive and effective The child was weaned from mechanical ventilation in four days No adverse event was detected in patients and caregivers during and post iNO therapy Conclusion： INO therapy is effective on cardiac surgery patients with pulmonary artery hypertension deterioration perioperatively Further clinical investigation is urgently needed for promogng it becoming a clinical routinely available therapy.