先心病根治手术及麻醉中一氧化氮吸入治疗肺动脉高压危象的指征与效果(英文)

THE USEFULNESS AND INDICATION OF NITRIC OXIDE INHALATION FOR INFANTS WITH PULMONARY HYPERTENSIVE CRISIS DURING CARDIAC SURGERY UNDER ANESTHESIA

目的 :观察术前肺血管阻力 (Rp)、肺动脉 /体循环压 (Pp/Ps)、肺循环 /体循环血流 (Qp/Qs)比值与术中肺 /体循环压力比值 (Pp/Ps)、肺循环 /体循脉高压危象的预测作用 ,及其以术中应用一氧化氮 (NO)的指征作用。同时 ,观察吸入对先心病伴肺动脉高压婴儿术中体外循环 (CPB)后肺动脉高压危象的治疗效果。方法 :本组病儿共 4 6例 ,术前心导管检查证实均为先心病伴肺动脉高压 ,并拟行心脏直视手术。术前用药及麻醉方法基本相同。术前Rp、Pp/Ps、Qp/Qs值在心导管检查时由Fick公式计算。CPB结束前分别在主肺动脉及升主动脉直接测定肺动脉高压 (Pp)和体循环压 (Ps) ,计算出术中Pp/Ps值 ,并将其与术前Rp、Pp/Ps、Qp/Qs值分别进行相关分析。CPB结束时PP/PS 比值 >1.0者诊断为肺动脉高压危象 ,并给予 4 0ppm的NO吸入 ,15min时再次测定PP/PS。结果 :术前Rp值与CPB脱机时的Pp/Ps比值呈正相关 (r2 =0 .86 ,P <0 .0 5 ,n =4 6 ) ,而术前Pp/Ps比值则与CPB脱机时的PP/PS 比值无明显关系。术前Rp <7.0Woodunitm2 的病例术中均未发生肺动脉高压危象。发生肺动脉高压危象的 4例中 ,术前Rp值中均中 9.0± 2 .6Woodunitm2 (7.4～ 12 )。NO吸入 15min时 ,其中 3例Pp/Ps从 1.0 7± 0 .0 6明显下降至 0 .6 7±0 .0 6 (P <0 .0

Objective: The effect of inhaled Nitric Oxide (NO) on pulmonary hypertension (PH) is well known, however, indication during cardiac surgery in infants with PH crisis is still unclear. In this study, we attempted to clarify it by using preoperative pulmonary vascular resistance (Rp) as an indicator. Method: 46 infants with PH were studied. Rp levels were calculated during cardiac catheterization by the Fick's Method. The relationship between preoperative Rp values and Pp/Ps ratio at the time of weaning from cardiopulmonary bypass (CPB) and the effect of inhaled NO at 40 ppm for 15 min on the PH crisis were evaluated. Results: Preoperative Rp values correlated positively with Pp/Ps ratio at the time of weaning from CPB (r 2=0.86, P< 0.05 , n=46). PH crisis was not observed in the cases with Rp values under 7 Wood unit m 2. PH crisis occurred only in 4 cases. Pp/Ps ratio fell significantly after NO inhalation (1.07±0.12 vs. 0.67±0.06, P<0.05) in three of them whose mRp value was 9.0±2.6 Wood unit m 2 (7.4～12). In the 4th case whose Rp value was 15 Wood unit m 2, inhalation of NO at 40 ppm was not effective. Conclusion: Inhaled NO therapy during cardiac surgery for infants with PH crisis may be indicated when Rp level is beyond 7.0 Wood unit m 2.