Murthy K S, Rao S G, Prakash K S, Robert C, Dhinakar S, Cherian K M
Institute of Cardio Vascular Diseases, Madras Medical Mission, Mogappair, Chennai.
Indian J Pediatr. 1999 May-Jun;66(3):357-61. doi: 10.1007/BF02845523.
Our aim was to assess the role of inhaled nitric oxide (NO) therapy in post operative cases of congenital heart defects who developed pulmonary arterial hypertensive (PAH) crisis and had no response with conventional management. From February '95 to January '97, inhaled NO therapy was used in 21 children. Age ranged from 2 months to 9 years (mean 5.6 years) and duration of therapy ranged from 1 to 13 days. Of 21 patients, 17 responded well with 5-20 ppm while 4 did not. The preoperative mean pulmonary systolic pressure was 88 mm Hg against mean systemic pressure of 96 mm Hg. Post operatively, their PA pressure reduced to 62 mm Hg, with systemic pressure of 98 mm Hg. After using inhaled NO, PA pressure dropped to 24 mm Hg (mean systolic) (p < 0.007), after excluding the non responders. Of 4 non responders, two died due to irreversible pulmonary vascular disease and remaining two died due to residual defects. The study shows that inhaled NO is a selective pulmonary vasodilator, which is useful in postoperative PAH crisis and also reduces the transpulmonary gradient in single ventricle repair cases. It is safe and effective for prolonged use. It is very useful in Indian perspective, when more number of cases with congenital heart defects (CHD) along with severe PAH are encountered routinely.
我们的目的是评估吸入一氧化氮（NO）疗法在先天性心脏病术后发生肺动脉高压（PAH）危象且对传统治疗无反应的病例中的作用。从1995年2月至1997年1月，对21名儿童使用了吸入NO疗法。年龄范围为2个月至9岁（平均5.6岁），治疗持续时间为1至13天。21例患者中，17例对5 - 20 ppm的剂量反应良好，4例无反应。术前平均肺动脉收缩压为88 mmHg，平均体循环压力为96 mmHg。术后，他们的肺动脉压力降至62 mmHg，体循环压力为98 mmHg。使用吸入NO后，排除无反应者，肺动脉压力降至24 mmHg（平均收缩压）（p < 0.007）。4例无反应者中，2例死于不可逆的肺血管疾病，其余2例死于残余缺陷。该研究表明，吸入NO是一种选择性肺血管扩张剂，对术后PAH危象有用，也可降低单心室修复病例中的跨肺压差。长期使用安全有效。从印度的角度来看，当经常遇到更多伴有严重PAH的先天性心脏病（CHD）病例时，它非常有用。
