先天性心脏病并肺动脉高压患儿术后雾化吸入前列腺素E_1对肺循环的影响

Influence of Post-operation Prostaglandin E1 Aerosol Inhalation on Pulmonary Circulation among Children Patients with Congenital Heart Disease Complicated with Pulmonary Hypertension

目的探讨先天性心脏病并肺动脉高压术后患儿雾化吸入前列腺素E1对肺循环的影响。方法选择先天性心脏病合并肺动脉高压、在全麻低温体外循环下行心内直视手术的患儿60例,按入科顺序随机分为3组各20例。3组患儿在术后常规脱离呼吸机后分别予雾化吸入生理盐水、硝普钠、前列腺素E1。观察比较3组雾化吸入前、吸入10、20、30 min,及停吸后10、30 min时的肺循环指标。结果3组雾化吸入前平均肺动脉压(MPAP)、肺阻力指数(PVRI)、动脉血氧分压(PaO2)及二氧化碳分压(PaCO2)比较,差异均无统计学意义(P>0.05)。雾化吸入10 min后前列腺素E1组和硝普钠组MPAP、PVRI均显著低于生理盐水组(P<0.05)。硝普钠组在吸入后30 min已显著降低的MPAP、PVRI在停吸后10 min内相应回升并反跳,且显著高于生理盐水组及前列腺素E1组(P<0.05),而雾化吸入前列腺素E1组在结束雾化30 min后未见反跳,且仍显著低于生理盐水组(P<0.05)。雾化吸入前列腺素E1后动脉血氧分压较吸入硝普钠和生理盐水升高(P<0.05),而二氧化碳分压下降(P<0.05),且停止雾化吸入后仍有持续作用(P<0.05);吸入硝普钠后动脉血氧分压、二氧化碳分压无变化,差异均无统计学意义(P>0.05)。结论先天性心脏病合并肺动脉高压术后患儿雾化吸入前列腺素E1更有利于降低肺动脉压,明显改善动脉血氧分压,预防肺动脉高压危象的发生。

Objective To explore the influence of post-operation prostaglandin E1 aerosol inhalation on pulmonary circulation among children patients with congenital heart disease complicated with pulmonary hypertension. Methods Sixty qualified patients undergoing open heart surgery under general anaesthesia were, in order of their admission to the department, randomly divided into 3 groups, each with 20. The three groups were, after being conventionally disconnected from the ventilator, offered aerosol inhalation of normal saline, sodium nitroprusside, and prostaglandin E1, respectively. Then comparisons were made of the pulmonary circulation indexes of the 3 groups before the inhalation, 10, 20 and 30 minutes after the beginning, and 10 and 30 minutes after the end, of the inhalation. Results The MPAP, PVRI, PaO2 and PaCO2 of the three groups before the inhalation had no statistically significant difference （P〉0.05）. 10 minutes after the beginning of the inhalation, the MPAP and PVRI of the prostaglandin E1 group and the nitroprusside group were significantly lower than those of the normal saline group （P〈0.05）. 10 minutes after the end of the inhalation, the MPAP and PVRI, which had markedly decreased after 30 minutes of inhalation, began to increase and rebound, and were distinctly higher than those of the other two groups （P〈0.05）. The MPAP and PVRI of the prostaglandin E1 group did not rebound 30 minutes after the end of the inhalation, and were markedly lower than those of the normal saline group （P〈0.05）, with its PaO2 higher than that of the other two groups （P〈0.05）, and the PaCO2 decreasing （P〈0.05） and having the continuing effect after the end of the inhalation. The PaO2 and PaCO2 of the nitroprusside group did not change after the inhalation （P〉0.05）. Conclusion Post-operation prostaglandin E1 aerosol inhalation better lowers pulmonary artery pressure, improves PaO2 and prevents the incidence of pulmonary artery hypertension.