Department of Intensive Care, Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
Murdoch Children's Research Institute, Melbourne, Australia.
Intensive Care Med. 2016 Nov;42(11):1744-1752. doi: 10.1007/s00134-016-4420-6. Epub 2016 Sep 30.
Cardiopulmonary bypass induces an ischaemia-reperfusion injury and systemic inflammatory response, which contributes to low cardiac output syndrome following cardiac surgery. Exogenous nitric oxide during cardiopulmonary bypass has shown potential to ameliorate such injury. We undertook a large randomised controlled trial to investigate the clinical effects of administering nitric oxide to the cardiopulmonary bypass circuit in children.
After written informed consent, children were randomised to receive 20 ppm nitric oxide to the gas inflow of the cardiopulmonary bypass oxygenator, or standard conduct of bypass.
101 children received nitric oxide and developed low cardiac output syndrome less frequently (15 vs. 31 %, p = 0.007) than the 97 children who did not receive nitric oxide. This effect was most marked in children aged less than 6 weeks of age (20 vs. 52 %, p = 0.012) and in those aged 6 weeks to 2 years (6 vs. 24 %, p = 0.026), who also had significantly reduced ICU length of stay (43 vs. 84 h, p = 0.031). Low cardiac output syndrome was less frequent following more complex surgeries if nitric oxide was administered (17 vs. 48 %, p = 0.018). ECMO was used less often in the nitric oxide group (1 vs. 8 %, p = 0.014).
Delivery of nitric oxide to the oxygenator gas flow during paediatric cardiopulmonary bypass reduced the incidence of low cardiac output syndrome by varying degrees, according to age group and surgery complexity.
ACTRN12615001376538.
体外循环会引起缺血再灌注损伤和全身炎症反应，这会导致心脏手术后出现低心输出综合征。体外循环期间给予外源性一氧化氮已显示出改善这种损伤的潜力。我们进行了一项大型随机对照试验，以研究在儿童中向体外循环回路中给予一氧化氮的临床效果。
在获得书面知情同意后，儿童被随机分配接受 20ppm 的一氧化氮进入体外循环氧气浓缩器的气体入口，或接受标准的体外循环。
101 名儿童接受了一氧化氮，发生低心输出综合征的频率较低（15%比 31%，p=0.007），而 97 名未接受一氧化氮的儿童则发生了低心输出综合征。这种效果在年龄小于 6 周的儿童（20%比 52%，p=0.012）和 6 周至 2 岁的儿童（6%比 24%，p=0.026）中最为显著，他们的 ICU 住院时间也显著缩短（43 比 84 小时，p=0.031）。如果给予一氧化氮，更复杂的手术中低心输出综合征的发生频率较低（17%比 48%，p=0.018）。一氧化氮组中使用 ECMO 的频率较低（1%比 8%，p=0.014）。
在儿科体外循环期间向氧气浓缩器气体流中输送一氧化氮，根据年龄组和手术复杂性的不同，在不同程度上降低了低心输出综合征的发生率。
ACTRN12615001376538。
