Cai Jiming, Su Zhaokang, Shi Zhenying, Zhou Yanping, Xu Zhiwei, Liu Jinfen, Chen Ling, Xu Zhuoming, Yu Xiaoqing, Ding Wenxiang, Yang Yanmin
Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Artif Organs. 2008 Nov;32(11):864-9. doi: 10.1111/j.1525-1594.2008.00643.x.
Inhaled nitric oxide (iNO) has been used for patients with increased pulmonary vascular resistance (PVR) shortly after Fontan operation, but repeat deterioration of PVR during or shortly after its withdrawal remains a major concern. Milrinone, a phosphodiesterase type 3 (PDE3) inhibitor, can also reduce PVR for postoperative patients with pulmonary hypertension. We hypothesized that iNO, in conjunction with milrinone, can provide additive benefits for pulmonary hemodynamics and reduce the occurrence of iNO withdrawal failure/rebound. Thirty-one patients with marked elevation of transpulmonary pressure gradient (TPG, >10 mm Hg) or central venous pressure (CVP, >15 mm Hg) after modified fenestrated Fontan operation were prospectively randomized into two groups, that is, group iNO (iNO at approximately 10 ppm, n = 15) and group iNO + Mil (iNO at approximately 10 ppm and milrinone at 0.5 microg/kg/min, n = 16). Hemodynamics, arterial blood oxygenation, and occurrence of withdrawal failure/rebound were compared between the two groups. Combined application of iNO and milrinone resulted in (i) more significant decrement of CVP (19.6 +/- 3.5% in group iNO + Mil vs. 15.2 +/- 4.6% in group iNO, P < 0.05) and TPG (18.2 +/- 4.8% in group iNO + Mil vs. 15.3 +/- 2.6% in group iNO, P < 0.05), (ii) more significant increment of systolic systemic arterial pressure (8.7 +/- 2.7% in group iNO + Mil vs. 5.2 +/- 3.1% in group iNO, P < 0.05), and (iii) more significant improvement of arterial oxygen saturation (9.3 +/- 3.2% in group iNO + Mil vs. 6.8 +/- 2.8% in group iNO, P < 0.01). Occurrence of iNO withdrawal failure during its weaning or rebound after its discontinuation was significantly lower in group iNO + Mil. The combined use of iNO and milrinone provided additive benefits as compared with exclusive use of iNO for patients with elevated PVR after Fontan procedure.
吸入一氧化氮（iNO）已用于Fontan手术后不久肺血管阻力（PVR）升高的患者，但在撤药期间或撤药后不久PVR反复恶化仍是一个主要问题。米力农是一种3型磷酸二酯酶（PDE3）抑制剂，也可降低肺动脉高压术后患者的PVR。我们假设，iNO与米力农联合使用，可为肺血流动力学带来附加益处，并减少iNO撤药失败/反弹的发生。31例改良开窗Fontan手术后经肺压力梯度（TPG，>10 mmHg）或中心静脉压（CVP，>15 mmHg）显著升高的患者被前瞻性随机分为两组，即iNO组（iNO浓度约为10 ppm，n = 15）和iNO + Mil组（iNO浓度约为10 ppm且米力农浓度为0.5 μg/kg/min，n = 16）。比较两组的血流动力学、动脉血氧合情况以及撤药失败/反弹的发生率。iNO与米力农联合应用导致：（i）CVP下降更显著（iNO + Mil组为19.6±3.5%，iNO组为15.2±4.6%，P < 0.05）以及TPG下降更显著（iNO + Mil组为18.2±4.8%，iNO组为15.3±2.6%，P < 0.05）；（ii）收缩期体动脉压升高更显著（iNO + Mil组为8.7±2.7%，iNO组为5.2±3.1%，P < 0.05）；（iii）动脉血氧饱和度改善更显著（iNO + Mil组为9.3±3.2%，iNO组为6.8±2.8%，P < 0.01）。iNO + Mil组在iNO撤机期间撤药失败或停药后反弹的发生率显著更低。与Fontan手术后PVR升高的患者单独使用iNO相比，iNO与米力农联合使用带来了附加益处。
