CAJ | 학술논문

目的评价吸入一氧化氮(NO)在Fontan手术后早期疗效.方法 20例患儿吸入NO(10～25)×10-6,定时记录各项血流动力学和呼吸功能指标,定期监测二氧化氮(NO2)、高铁血红蛋白(MetHb)含量.结果吸入NO后,中心静脉压(CVP)从(20.8±4.8)mm Hg(1 mm Hg=0.133 kPa)降至(14.3±1.8)mm Hg,跨肺压从(16.3±3.0)mm Hg降至(8.8±2.1)mm Hg,氧合指数从(70.3±16.9)mm Hg升至(120.5±14.0)mm Hg,动脉血氧饱和度从0.78±0.14升至0.91±0.09,血乳酸值从(3.98±0.86)mmol/L降至(1.29±1.60)mmol/L,差异均有显著性(P<0.05).吸入NO期间,NO2和MetHb含量均在安全范围.结论吸人NO对Fontan手术后远期疗效无明显影响,但其有助于避免术后早期肺血管阻力一过性升高所致的低心排血量综合征及腔静脉高压,明显改善呼吸功能,是一种安全且理想的肺血管扩张剂.
목적 평개흡입일양화담(NO)재Fontan수술후조기료효.방법 20례환인흡입NO(10～25)×10-6,정시기록각항혈류동역학화호흡공능지표,정기감측이양화담(NO2)、고철혈홍단백(MetHb)함량.결과 흡입NO후,중심정맥압(CVP)종(20.8±4.8)mm Hg(1 mm Hg=0.133 kPa)강지(14.3±1.8)mm Hg,과폐압종(16.3±3.0)mm Hg강지(8.8±2.1)mm Hg,양합지수종(70.3±16.9)mm Hg승지(120.5±14.0)mm Hg,동맥혈양포화도종0.78±0.14승지0.91±0.09,혈유산치종(3.98±0.86)mmol/L강지(1.29±1.60)mmol/L,차이균유현저성(P<0.05).흡입NO기간,NO2화MetHb함량균재안전범위.결론 흡인NO대Fontan수술후원기료효무명현영향,단기유조우피면술후조기폐혈관조력일과성승고소치적저심배혈량종합정급강정맥고압,명현개선호흡공능,시일충안전차이상적폐혈관확장제.
Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.