雾化吸入硝普钠治疗左向右分流先天性心脏病并肺动脉高压的临床研究

Nebulized Sodium Nitroprusside in Treatment of Left to Right Shunting Congenital Heart Disease Complicated with Pulmonary Arterial Hypertension

目的观察雾化吸入硝普钠(neb-SNP)治疗左向右分流先天性心脏病(CHD)并肺动脉高压(PAH)的疗效,探讨治疗PAH的新途径及可能的机制。方法选择确诊为CHD并PAH的患儿20例,观察neb-SNP 5 mg/mL前(基础值),neb-SNP后5、10、30、60 min肺动脉平均压(PAMP)、肺动脉收缩压(PASP)、血氧饱和度(SaO2)、平均动脉压(MAP)、心率(HR)、右室射血前期(RPEP)/加速时间(AT)、左室射血分数(LVEF)以及Tei指数的变化。结果应用neb-SNP后,PAMP、PASP、Tei指数、RPEP/AT均较基础值有明显下降(P<0.05),SaO2、LVEF较基础值有明显升高(P<0.05),而MAP、HR与基础值相比差异无统计学意义(P>0.05)。结论Neb-SNP可选择性降低肺动脉压力,改善心功能,提高动脉氧分压,为治疗PAH可能提供了又一简便可行、安全有效的方法。

Objective To evaluate the clinical effect and possible mechanism of nebulized sodium nitroprusside（neb-SNP） on pulmonary arterial hypertension （PAH） secondary to left to right shunting congenital heart disease （CHD）. Methods 20 patients with PAH secondary to CHD were treated with 5 mg/mL neb-SNP. The pulmonary artery mean pressure （PAMP）, pulmonary artery systolic pressure （PASP）,oxygen saturation （SaO2）, mean arterial pressure （MAP）,heart rate （HR）,right ventricular preejection period （RPEP）/accelerate time （AT）,left ventricular ejection fraction （LVEF） and Tel index were monitored before neb-SNP treatment and 5,10,30 and 60 min after neb-SNP treatment respectively. Results The PAMP, PASP, Tei index and RPEP/AT were obviously decreased （P 〈 0. 05）, and SaO2, LVEF were significantly increased （P〈0.05） in 5,10,30 or 60 min after inhalation of SNP treatment; while the MAP, HR were rarely alteration （P〉0.05）. Conclusion Neb-SNP can selectively lower pulmonary artery pressure, improve the cardiac function and oxygen pressure. It may be a convenient and safe way for the treatment of PAH secondary to CHD.