吸入一氧化氮对心瓣膜置换术后肺动脉高压患者血流动力学的影响

Influence of inhaled nitric oxide on hemodynamics in patients with pulmonary hypertension after mitral valve replacement

目的：观察吸入一氧化氮（ＮＯ）对心瓣膜置换术后肺动脉高压患者血流动力学的影响。方法：选择９例心瓣膜置换术后伴肺动脉高压的病人，吸入ＮＯ０．００３％，观察三个时象点：吸入ＮＯ前；开始吸入ＮＯ后１５分钟；停止吸入ＮＯ后１５分钟。结果：吸入ＮＯ能显著降低肺动脉压和肺循环阻力指数（Ｐ＜０．０１），停止吸入ＮＯ１５分钟后，肺动脉压和肺循环阻力指数恢复到原有水平。在整个观察过程中，心率、平均动脉压、中心静脉压、肺动脉楔压、体循环阻力指数和心脏指数均无显著变化（Ｐ＞０．０５）。结论：吸入ＮＯ具有选择性肺血管扩张作用，是治疗心瓣膜置换术后肺动脉高压的较理想药物。

Objective:To assess the effects of inhaled nitric oxide on hemodynamics in patients with pulmonary hypertension Methods:Nine patients with pulmonary hypertension after mitral valve replacement were enrolled in our study Three points were observed:(1)baseline,(2)fifteenth minutes after beginning nitric oxide inhalation,and(3)fifteenth minutes after stopping nitric oxide inhalation Results:Inhaled nitric oxide 0 003% reduced mean pulmonary artery pressure(mPAP) from 4 67±0 74 kPa to 3 84±0 60 kPa(P<0 01) and pulmonary vascular resistance index (PVRI) from 885±297 to 626±229 dyn·s·cm -5 ·m -2 (P<0 01),at fifteenth minute after stopping nitric oxide inhalation,mPAP and PVRI returned to the baseline During the period of observation,heart rate,mean systemic artery pressure,pulmonary artery wedge pressure and cardiac index had no significant change (P<0 05) Conclusions:Inhaled nitric oxide can selectively dilate the pulmonary circulation and is very beneficial to the patients with pulmonary hypertension after cadiac surgery