吸入一氧化氮和伊洛前列素治疗婴幼儿先天性心脏病术后中重度肺动脉高压的随机对照研究

Comparison of inhaled nitrioxide and Iloprosin infantwith moderate osevere pulmonary hypertension af-tecardiasurgery：prospective randomized trial

目的比较吸入外源性一氧化氮（NO）和伊洛前列素（Iloprost）对先天性心脏病（先心病）术后中重度肺动脉高压（PH）的治疗效果。方法对2011年1月至2014年1月复旦大学附属儿科医院40例术后存在中重度PH的先心病患儿进行前瞻性、随机对照研究。患儿年龄为1～24个月，体质量为3．2～11．0kg。分别给予吸人NO（NO组，20例）和雾化吸入Iloprost（Iloprost组，20例）治疗。Iloprost组先吸入Iloprost10min，吸入剂量50ng／（kg·min），随之联合吸入NO20×10～10min。NO组先吸入NO20×10～10rain，随之联合吸入Iloprost10min，吸入剂量50ng／（kg·min）。检测用药前后心率、收缩压、肺动脉压（PAP）、中心静脉压等血流动力学参数。同时检测吸入NO后二氧化氮（NO：）和高铁血红蛋白（MetHb）水平。结果单纯吸入NO和Iloprost均能显著降低PAP（t=4．670，P=0．009；t=3．762，P=0．004）和肺循环／体循环压力比值（t=16．974，P=0．000；t=9．682，P=0．000），改善氧合指数，但联合应用吸入NO和Iloprost并未显示出较单纯应用更明显的效果。对PAP降低的幅度比较，吸入NO和Iloprost之间比较差异无统计学意义（F=2．742，P=0．129）。吸入NO后监测N02和MetHb水平均在正常范围内。结论吸入NO和Iloprost对先心病术后中重度PH均有显著治疗作用，二者作用效果相近。相比吸入NO的潜在毒性和所需复杂的输送监测设备，临床治疗时考虑首选合适剂量的Iloprost可能更为合理、可行。

Objective To compare the efficacy of inhaled Iloprosand nitrioxide （NO） in infantwith moderate osevere pulmonary hypertension （PH） aftecongenital heardisease surgery. MethodThiwaprospective randomized study in Children＇Hospital of Fudan University from January 2011 to January 2014, including 40 in- fantwho suffered from moderate to severe PH aftehearsurgery. Theiageranged from 1 to 24 months. Theiweighranged from 3.2 to 11.0 kg. They were randomly allocated to inhale NO （ NO group, n = 20） oIlopros（ Iloprosgroup,n = 20）. Iloprosgroup wagiven Iloproswith 50 ng/（ kg · min） fo10 min and then combined with NO 20 x 10-6 fo10 min;NO group wafirsgiven 20 x 10-6 of NO fo10 min,then combined with Ilopros50 ng/（kg· min） fo10 min. Hearrate, systoliblood pressure, pulmonary artery pressure（PAP） and central venoupressure were recor- ded continuously. Athe same time, the concentration of nitrogen dioxide and methemoglobin afteinhaling NO wade- tected. ResultInhaled Iloprosand NO caused significanreduction in PAP （ = 4. 670, P = 0. 009 ; = 3. 762, P = 0. 004） and pulmonary - to - systemipressure ratio （Pp/Ps） （= 16.974, P = 0.000 ; = 9.682, P = 0.000） busignifi- canincrease in oxygen index separately. The combination had no additional effeccompared with single application. In term of the reduction of PAP, there wano significandifference between inhaled Iloprosand NO （ F = 2. 742, P = 0. 129）. The levelof nitrogen dioxide and methemoglobin were noabove the normal limits. ConclusionModerate to severe PH aftecardiasurgery wasignificantly reduced by inhaled NO and Iloprost. They had similaeffects. However, the combination of both vasodilatorfailed to prove more potenthan eithesubstance alone. Compared with the potential toxicity of NO,the individual differenceand the complex transmission, Iloprosmay be more reasonable and feasible fothe nostonerative treatmenof PH.