吸入一氧化氮治疗二尖瓣狭窄术后肺动脉高压的研究

Therapeutic effects of inhaled nitric oxide in patients with pulmonary hypertension after mitral valve replacement

目的 观察吸入NO治疗二尖瓣狭窄 (MS)术后肺动脉高压 (PH)的疗效。方法 30例MS二尖瓣置换 (MVR)术后PH病人 ,吸入 2 0ppmNO 30min后 ,停吸NO ,15min后再吸入 6 ppmNO ,直至脱离呼吸机。采用Swan Ganz导管技术监测吸入前后的血液动力学及氧合指标。结果 吸入2 0 ppmNO 5min后 ,肺动脉压、肺循环阻力、肺泡动脉血氧分压差及肺内分流率明显降低 ,动脉血氧分压、动脉血氧含量、氧供指数明显提高 (P <0 0 5或 0 0 1) ,而肺毛细血管楔压、中心静脉压、心率、心排血量、心脏指数、体循环阻力无显著性改变 (P >0 0 5 )。停吸NO 15min后 ,以上指标恢复至吸入NO前水平 ;再次吸入 6ppmNO 15min后 ,以上指标又恢复至吸入 2 0 ppmNO后水平 ,持续 6 ppmNO吸入 5h ,各指标维持稳定 ,脱离呼吸机后 15min以上指标亦无明显变化。结论 吸入NO是治疗心脏病手术后PH的一种有效的方法。

Objective To assess therapeutic effects of inhaled nitric oxide in patients with pulmonary hypertension (PH) after mitral valve replacement(MVR) Methods Thirty patients with PH (mPAP>2 67kPa) after MVR were enrolled in the study Parameters in hemodynamics and oxygenation were measured with Swan Ganz technique , 5min before NO inhalation (T 1), 5,15 and 30min following NO 20ppm inhalation (T 2,T 3,T 4), 15min after stopping NO 20ppm inhalation (T 5), 15min and 5h following NO 6ppm inhalation (T 6,T 7) and 15min before and after weaning from mechanical ventilator (T 8,T 9) respectively Results Compared with those at T 1, at T 2 pulmonary artery pressure, pulmonary vascular resistance, alveolar arterial oxygen difference and intrapulmonary shunting significantly decreased, but arterial oxygen partial pressure, oxygen content and oxygen availability index increased significantly (P<0 05 or 0 01) At T 5, all parameters above returned to the levels at T 1 At T 6 all parameters above returned to the levels at T 2 and were kept at these levels from T 7 to T 9 The pulmonary capillary wedge pressure, central venous pressure, heart rate, cardiac output, cardiac index and systemic vascular resistance remained unchanged markedly during whole procedures (P>0 05) Conclusions The persistently inhaled low dose NO is effective and safe for the pulmonary hypertension induced with heart surgery