一氧化氮吸入治疗在Fontan手术后早期的应用

Application of inhaled nitric oxide in the early period after Fontan operation

目的 评价吸入一氧化氮（NO）在Fontan手术后早期疗效.方法 20例患儿吸入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（NO2）、高铁血红蛋白（MetHb）含量.结果 吸入NO后,中心静脉压（CVP）从（20.8±4.8）mm Hg（1 mm Hg=0.133 kPa）降至（14.3±1.8）mm Hg,跨肺压从（16.3±3.0）mm Hg降至（8.8±2.1）mm Hg,氧合指数从（70.3±16.9）mm Hg升至（120.5±14.0）mm Hg,动脉血氧饱和度从0.78±0.14升至0.91±0.09,血乳酸值从（3.98±0.86）mmol/L降至（1.29±1.60）mmol/L,差异均有显著性（P〈0.05）.吸入NO期间,NO2和MetHb含量均在安全范围.结论 吸人NO对Fontan手术后远期疗效无明显影响,但其有助于避免术后早期肺血管阻力一过性升高所致的低心排血量综合征及腔静脉高压,明显改善呼吸功能,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 the early period after Fontan operation. Methods Twenty children receiving INO [（10 ～ 25） × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin （MetHb）and nitrogen dioxide（NO2）were monitored. Results In INO therapy group,CVP decreased from （20.8±4.8） mm Hg to （14.3±1.8） mm Hg,TPG decreased from （16.3 ±3.0） mm Hg to （8.8±2. 1） mm Hg,PaO2/FiO2 increased from （70.3±16.9） mm Hg to （120.5 ±14.0） mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from （3.98 ± 0. 86） mmol/L to （1.29 ± 1.60） mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.