Department of Cardiac Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece.
J Cardiothorac Vasc Anesth. 2013 Jun;27(3):459-66. doi: 10.1053/j.jvca.2012.07.020. Epub 2012 Oct 10.
The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide (NO) plus aerosolized iloprost in patients with pulmonary hypertension/right ventricular dysfunction after cardiac surgery.
A retrospective study.
A single center.
Eight consecutive patients with valve disease and postextracorporeal circulation (ECC) pulmonary hypertension/right ventricular dysfunction.
The continuous inhalation of nitric oxide (10 ppm) and iloprost, 10 μg, in repeated doses.
The hemodynamic profile was obtained before inhalation, during the administration of inhaled NO alone (prior and after iloprost), and after the first 2 doses of iloprost. Tricuspid annular velocity and tricuspid annular plane systolic excursion were estimated at baseline and before and after adding iloprost. At the end of the protocol, there were significant decreases in pulmonary vascular resistance (p < 0.001), the mean pulmonary arterial pressure (p < 0.001), and the mean pulmonary artery pressure/mean arterial pressure ratio (p = 0.006). Both tricuspid annular velocity (p < 0.001) and tricuspid annular plane systolic excursion (p < 0.001) increased. The cardiac index (p < 0.001) and venous blood oxygen saturation (p = 0.001) increased throughout the evaluation period. Each iloprost dose was associated with further decreases in pulmonary vascular resistances/pressure. By comparing data at the beginning of inhaled NO with those after the second dose of iloprost, the authors noticed decreases in pulmonary vascular resistances (p = 0.004) and the mean pulmonary artery pressure (p = 0.017) and rises in tricuspid annular velocity (p < 0.001) and tricuspid annular systolic plane systolic excursion (p < 0.001).
Inhaled NO and iloprost significantly reduced pulmonary hypertension and contributed to the improvement in right ventricular function. Inhaled NO and iloprost have additive effects on pulmonary vasculature.
本研究旨在评估吸入一氧化氮（NO）联合吸入伊洛前列素在体外循环（ECC）后肺动脉高压/右心功能障碍患者中的血流动力学效应。
回顾性研究。
单中心。
连续 8 例瓣膜病合并 ECC 后肺动脉高压/右心功能障碍患者。
持续吸入一氧化氮（10ppm）和伊洛前列素，10μg，重复剂量。
在吸入前、单独吸入一氧化氮时（吸入伊洛前列素前后）以及吸入伊洛前列素后前 2 个剂量时，获得血流动力学特征。在基线和添加伊洛前列素前后，估计三尖瓣环速度和三尖瓣环平面收缩期位移。在方案结束时，肺血管阻力（p<0.001）、平均肺动脉压（p<0.001）和平均肺动脉压/平均动脉压比值（p=0.006）均显著降低。三尖瓣环速度（p<0.001）和三尖瓣环平面收缩期位移（p<0.001）均增加。心指数（p<0.001）和静脉血氧饱和度（p=0.001）在整个评估期间增加。每个伊洛前列素剂量与肺血管阻力/压力的进一步降低相关。将吸入一氧化氮开始时的数据与伊洛前列素第二次剂量后的数据进行比较，作者注意到肺血管阻力（p=0.004）和平均肺动脉压（p=0.017）降低，三尖瓣环速度（p<0.001）和三尖瓣环平面收缩期位移（p<0.001）升高。
吸入一氧化氮和伊洛前列素显著降低肺动脉高压，有助于改善右心功能。吸入一氧化氮和伊洛前列素对肺血管具有相加作用。
