Cardiovascular Intensive Care Unit, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex, USA.
J Thorac Cardiovasc Surg. 2013 Sep;146(3):530-6. doi: 10.1016/j.jtcvs.2012.09.100. Epub 2012 Dec 8.
Cardiac surgery requiring cardiopulmonary bypass and cardioplegic arrest leads to myocardial ischemic and reperfusion injury. Gaseous nitric oxide has been demonstrated to have a myocardial protective effect following ischemia-reperfusion. We hypothesized that gaseous nitric oxide administered during cardiopulmonary bypass would have similar beneficial effects.
In a prospective, randomized, blinded, placebo-controlled study, children undergoing repair of tetralogy of Fallot received either 20 ppm of gaseous nitric oxide or placebo delivered to the membrane oxygenator during cardiopulmonary bypass.
A total of 16 children were randomized into 2 equal groups once their parents or guardians had given written informed consent. No differences were found in age, crossclamp time, cardiopulmonary bypass time, or methemoglobin between the 2 groups. The group receiving gaseous nitric oxide had a significantly shortened duration of mechanical ventilation (8.4 ± 7.6 vs 16.3 ± 6.5 hours; P < .05) and intensive care unit length of stay (53.8 ± 19.7 vs 79.4 ± 37.7 hours; P < .05) compared with the placebo group. The patients had significantly lower troponin levels at 12, 24, and 48 hours (P < .05) and lower B-type natriuretic peptide levels at 12 and 24 hours (P < .05). A trend was found toward a less positive fluid balance, with significantly less diuretic usage. The study patients had a greater mean hemoglobin at 48 hours, despite the absence of differences in chest tube output, packed red blood cell transfusion, platelet counts or transfusion requirements, fresh frozen plasma transfusion, or prothrombin time/partial thromboplastin time in the first 48 hours.
The delivery of gaseous nitric oxide to the cardiopulmonary bypass circuit for children undergoing cardiac surgery results in myocardial protection, improved fluid balance, and an improved postoperative intensive care unit course.
体外循环和心脏停搏导致心肌缺血再灌注损伤，需要心脏手术。已经证明气态一氧化氮在缺血再灌注后具有心肌保护作用。我们假设在体外循环期间给予气态一氧化氮会产生类似的有益效果。
在一项前瞻性、随机、盲法、安慰剂对照研究中，接受法洛四联症修复术的儿童在体外循环期间接受 20 ppm 的气态一氧化氮或安慰剂输送至膜式氧合器。
在获得其父母或监护人的书面知情同意后，共有 16 名儿童随机分为两组。两组之间的年龄、阻断时间、体外循环时间或高铁血红蛋白无差异。与安慰剂组相比，接受气态一氧化氮组的机械通气时间（8.4 ± 7.6 与 16.3 ± 6.5 小时；P <.05）和重症监护病房住院时间（53.8 ± 19.7 与 79.4 ± 37.7 小时；P <.05）明显缩短。与安慰剂组相比，患者在 12、24 和 48 小时时的肌钙蛋白水平显著降低（P <.05），在 12 和 24 小时时的 B 型利钠肽水平显著降低（P <.05）。液体平衡呈正性趋势，利尿剂用量明显减少。尽管在第 48 小时，两组的胸腔引流管输出、红细胞悬液输注、血小板计数或输注需求、新鲜冰冻血浆输注或凝血酶原时间/部分凝血活酶时间无差异，但研究患者的平均血红蛋白更高。
在接受心脏手术的儿童体外循环回路中输送气态一氧化氮可导致心肌保护、改善液体平衡，并改善术后重症监护病房的病程。
