吸入一氧化氮治疗心脏直视手术后难治性低氧血症的疗效分析

Effects of inhaled nitric oxide in refractory hypoxemic patients after open heart surgery

目的分析使用吸入一氧化氮（NO）治疗心脏直视手术后难治性低氧血症的临床疗效。方拔研究对象为心脏直视手术后返回重症监护病房的严重性低氧血症患者，体循环基本稳定，已给予充分治疗，而氧合指数（动脉血氧分压／吸入氧浓度，PaO2／FiO2）〈100mmHg（1mmHg=0．133kpa）超过4h。NO接入呼吸回路的吸入端，设置NO吸入浓度为5～10ppm。共入组17例患者，记录患者的各项临床资料，比较NO吸入前，吸入1h和24h后的氧合指数和循环指标的变化。结果17例吸入NO治疗的患者中，住院期间死亡6例，11例治愈出院。与NO吸入前比较，吸入1h后氧合指数明湿改善[（105．1±22．1）mmHgw（77．9±15．6）mmHg]（P〈0．01），吸入24h后进一步改善[（141．1±50．6）mmHgvs（105．1±22．1）mmHg]（P〈0．05）；吸入NO1h后，心率、血压和多巴胺剂量无明娃变化（P〉0．05）；吸入NO24h后，心率较吸入NO1h后明旺降低[（85．1±14．5）次／rainvs（96。2±22．4）次／min]（P〈0．05）。未发现与NO相关的不良反应。结论吸入NO治疗心脏手术后难治性低氧血症患者可即刻改善氧合指数，不影响血流动力学，对非感染性患者效果好。

Objective To evaluate the clinical effects of inhaled nitric oxide （NO） on patients with refractory hypoxemia after open heart surgery. Methods The patients in ICU with stable circulation but their PaO2FiO2 （arterial oxygen tension/fraction of inspired oxygen） 〈 100 mmHg （1 mmHg = 0. 133 kPa） over 4 h after cardiac surgery were given NO treatment. The concentration of inhaled NO was 5 - 10 ppm. Values of oxygenation and circulation index before, 1 h after, and 24 h after NO treatment were compared for 17 patients. Results Among 17 patients, 6 died and 11 were cured. After NO was inhaled for 1 h, PaO2/FiO2 improved significantly [（105. 1 ±22. 1） mmHg vs （77. 9 ± 15.6） mmHg] （P 〈0.01）, and further improved after 24 h [ （141. 1 ±50. 6） mmHg vs （105. 1 ±22. 1） mmHg] （P 〈0.05）, during which heart rate, mean arterial pressure, and dopamine dose remained unchanged except that after 24 h the heart rate decreased [（85.1 ±14.5）/rain vs （96.2±22.4）/mini （P 〈0.05）. There were no side effects relevant to inhaling NO. Conclusion For patients with refractory hypoxemia after cardiac surgery, inhaling NO can improve PaO2/FiO2 without causing side effects on hemodynamics.