吸入一氧化氮治疗先天性心脏病术后肺动脉高压的疗效观察

The application of inhaled nitric oxide in management of postoperative pulmonary hypertension

目的 探讨吸入一氧化氮（NO）治疗先天性心脏病术后肺动脉高压患儿的疗效.方法 选择32例先天性心脏病术后传统治疗无效的、难治的、反应性肺动脉高压或肺动脉高压危象患儿,吸入NO（10～25）×10-6,定时记录各项血流动力学和呼吸功能指标,定期监测二氧化氮、高铁血红蛋白含量.结果 吸入NO后,平均肺动脉压（mPAP）从（38.0±3.2）mm Hg（1 mm Hg=0.133 kPa）降至（28.0±2.1）mm Hg,肺血管阻力从（62.2±6.7）kPa/（L·S）降至（49.9±5.6）kPa/（L·S）,氧合指数从（67.0±30.1）mm Hg升至（92.6±25.0）mm Hg,动脉血氧饱和度从0.78±0.14升至0.84±0.09,差异均有非常显著性（P＜0.01）.吸入NO期间,二氧化氮和高铁血红蛋白含量均在安全范围.结论 NO可以明显降低先天性心脏病术后肺动脉压力和肺血管阻力,是一种安全且理想的肺血管扩张剂.

Objective To evaluate the effects of inhaled nitric oxide （iNO） in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure（mPAP） decreased from （38.0 ±3.2） mm Hg to （28.0 ±2.1） mm Hg,pulmonary vascular resistance （PVR） decreased from （62.2 ±6.7） kPa/（L·S） to （49.9 ±5.6） kPa/（L·S） ,PaO2/FiO2increased from （67.0 ±30. 1 ） mm Hg to （92. 6 ±25.0） mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.