Ware Linda E
Le Bonheur Children's Medical Center, Memphis, Tennessee 38103, USA.
Crit Care Nurs Clin North Am. 2002 Mar;14(1):1-6. doi: 10.1016/s0899-5885(03)00032-7.
NO has been used successfully to treat PPHN, reducing the need for ECMO. NO has also been used in the cardiac catheterization laboratory to determine if pulmonary hypertension will decrease with NO. Patients who do not respond to NO are at higher risk after open-heart surgery, because their pulmonary hypertension will be difficult to treat. Postoperatively, NO can be used to determine if pulmonary hypertension is caused by vasoconstriction or by an obstruction. Inhaled Nitric Oxide at a Glance:
Selective pulmonary vasodilation without systemic vasodilation. USE: Treatment of pulmonary hypertension.
Lowest concentration that will produce pulmonary vasodilation and improved oxygenation. Concentration should be kept < 80 ppm.
Neonate that is ductal-dependent.
Keep methemoglobin level < 5%. Keep nitric dioxide, which can cause lung damage, < 7 ppm. Risk of bleeding.
Levels of NO/NO2. Platelets. Arterial blood gas (ABG). Methemoglobin.
Decrease NO by 20%, monitoring ABG at 3- to 4-hour intervals. If there is a decrease in oxygenation, increase NO. Increase FIO2 20% when NO is discontinued. Unsuccessful treatment with NO--keep on NO until ECMO is available.
一氧化氮已成功用于治疗新生儿持续性肺动脉高压（PPHN），减少了体外膜肺氧合（ECMO）的使用需求。一氧化氮也已用于心导管实验室，以确定肺动脉高压是否会因一氧化氮而降低。对一氧化氮无反应的患者在心脏直视手术后风险更高，因为他们的肺动脉高压将难以治疗。术后，一氧化氮可用于确定肺动脉高压是由血管收缩还是阻塞引起的。一氧化氮吸入概述：
选择性肺血管舒张而无全身血管舒张。
治疗肺动脉高压。
产生肺血管舒张和改善氧合的最低浓度。浓度应保持<80 ppm。
依赖动脉导管的新生儿。
使高铁血红蛋白水平<5%。使可能导致肺损伤的二氧化氮<7 ppm。有出血风险。
一氧化氮/二氧化氮水平。血小板。动脉血气（ABG）。高铁血红蛋白。
一氧化氮浓度降低20%，每隔3至4小时监测动脉血气。如果氧合下降，则增加一氧化氮浓度。停用一氧化氮时，将吸入氧浓度（FIO2）提高20%。一氧化氮治疗失败——持续使用一氧化氮直至可使用体外膜肺氧合。
