吸入一氧化氮对先心病肺动脉高压的术前评价

THE EVALUATION OF INHALED NITRIC OXIDE TO CONGENITAL HEART DISEASE WITH PULMONARY HYPERTENSION IN PRE-OPERATION

目的 :应用自行研制的脉冲式吸入一氧化氮诊疗仪 ,对先天性心脏病合并肺动脉高压 (PH)的患者进行肺血管的术前评价。方法 :选择先天性心脏病合并 PH的患者 ,于术前通过脉冲式吸入一氧化氮诊疗仪吸入 NO,吸入浓度为 2 0 ppm,超声心动图分别测量并计算吸入 NO前、吸入 NO2 0 min时及停止吸入 NO30 m in后的肺动脉压 (PAP)、心输出量 (CO)、肺血管阻力 (PVR)。无创监护仪测量末梢血 Sa O2 、BP、HR。 NO吸入结束时测定高铁血红蛋白 (m et Hb)。结果 :除 2例患者吸入 NO2 0 ppm后无反应 ,NO浓度增加至 6 0 ppm外 ,其余患者吸入 NO2 0 ppm后 ,PAP、PVR、CO和吸前比较均有明显降低 (P<0 .0 1) ,停吸后较短时间回到基线。BP、HR变化不明显 ,吸入 NO后 m et Hb化验均正常。结论 :NO吸入对于先心病 PH的判断较敏感 ,方法简单、安全、经济。

Objective:In order to evaluate the effect of inhaled nitric oxide(NO) to congenital heart disease(CHD) with pulmonary hypertension(PH) in pre-operation.Method:Eighteen patients with CHD associated with PH were chosen to inhale 20 ppm NO for 20 min pre-operation with the pulsed inhaled NO flow controlling instrument.Pulmonary vascular resistance(PVR),pulmonary artery pressure(PAP),cardiac output(CO),SaO 2,BP,HR and metHb were determined at three points data collection:before NO ,with 20 ppm NO (if no effects,to 60 ppm),and after NO.Result:Inhaled NO produced selective pulmonary vasorelaation.All patients of PAP,PVR,CO were lowered(P<0.01).PVR,PAP and CO returned to baseline after withdrawal of inhaled NO.All patients of metHb,SaO 2,HR and BP did not change.Conclusion:Nitric oxide may be used as an effective pulmonary vasodilator to assess the vasodilatory capacity of the pulmonary circulation in the pre-operation. [