Kadosaki Mamoru, Kawamura Takae, Oyama Kotaro, Nara Noriko, Wei Jicheng, Mori Naohisa
Department of Anesthesiology, Iwate Medical University Memorial Heart Center, Iwate, Japan.
Anesthesiology. 2002 Apr;96(4):835-40. doi: 10.1097/00000542-200204000-00009.
The beneficial effect of inhaled nitric oxide (NO) on pulmonary hypertension is well known. However, the indications for NO inhalation therapy for pulmonary hypertension associated with congenital heart lesions are still unclear. The aim of the current study was to seek a measure that would predict the effectiveness of inhaled NO in infants undergoing cardiac surgery.
Forty-six infants with pulmonary hypertension were studied. Pulmonary vascular resistance (PVR) measured at the time of cardiac catheterization was used as an indicator and compared with pulmonary arterial pressure/systemic blood pressure ratio (Pp/Ps) at the time of weaning from cardiopulmonary bypass. The effect of 40 ppm of inhaled NO for 15 min was evaluated in patients whose Pp exceeded systemic values.
Preoperative PVR correlated positively with Pp/Ps at the time of weaning from cardiopulmonary bypass (r2 = 0.86; P < 0.05; n = 46). A Pp/Ps greater than or equal to 1 was not observed in any cases in which the preoperative PVR values were less than 7 Wood units m2; Pp/Ps ratio greater than or equal to 1 occurred in four patients. Each of these had PVR values greater than 7 Wood units m2. Three of these patients who had PVR values in the 7-12 Wood units m2 range were responsive to inhaled NO. The fourth patient, whose PVR value was greater than 15 Wood units m2, was unresponsive. Lung biopsy specimens were obtained in two patients whose preoperative PVR values were greater than 10 Wood units m2.
Preoperative PVR correlates reasonably well with postbypass Pp/Ps.
吸入一氧化氮（NO）对肺动脉高压具有有益作用，这是众所周知的。然而，与先天性心脏病变相关的肺动脉高压患者吸入NO治疗的适应症仍不明确。本研究的目的是寻找一种能够预测吸入NO对接受心脏手术婴儿有效性的指标。
对46例患有肺动脉高压的婴儿进行了研究。将心导管检查时测得的肺血管阻力（PVR）作为指标，并与体外循环脱机时的肺动脉压/体循环血压比值（Pp/Ps）进行比较。对Pp超过体循环值的患者评估吸入40ppm NO 15分钟的效果。
术前PVR与体外循环脱机时的Pp/Ps呈正相关（r2 = 0.86；P < 0.05；n = 46）。术前PVR值小于7伍德单位/m2的任何病例中均未观察到Pp/Ps大于或等于1；4例患者的Pp/Ps比值大于或等于1。这些患者的PVR值均大于7伍德单位/m2。其中3例PVR值在7 - 12伍德单位/m2范围内的患者对吸入NO有反应。第4例患者的PVR值大于15伍德单位/m2，无反应。对2例术前PVR值大于10伍德单位/m2的患者进行了肺活检。
术前PVR与体外循环后的Pp/Ps有较好的相关性。
