Tominaga Yuji, Iwai Shigemitsu, Yamauchi Sanae, Kyogoku Miyako, Kugo Yosuke, Hasegawa Moyu, Kayatani Futoshi, Takahashi Kunihiko, Aoki Hisaaki, Takeuchi Muneyuki, Tachibana Kazuya, Kawata Hiroaki
Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, 594-1101, Osaka, Japan.
Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, 594-1101, Osaka, Japan.
Pediatr Cardiol. 2019 Jun;40(5):1064-1071. doi: 10.1007/s00246-019-02122-2. Epub 2019 May 7.
In 2014, our hospital introduced inhaled nitric oxide (iNO) therapy combined with high-flow nasal cannula (HFNC) oxygen therapy after extubation following the Fontan procedure in patients with unstable hemodynamics. We report the benefits of HFNC-iNO therapy in these patients. This was a single-center, retrospective review of 38 patients who underwent the Fontan procedure between January 2010 and June 2016, and required iNO therapy before extubation. The patients were divided into two groups: patients in Epoch 1 (n = 24) were treated between January 2010 and December 2013, receiving only iNO therapy; patients in Epoch 2 (n = 14) were treated between January 2014 and June 2016, receiving iNO therapy and additional HFNC-iNO therapy after extubation. There were no significant differences between Epoch 1 and 2 regarding preoperative cardiac function, age at surgery, body weight, initial diagnosis (hypoplastic left heart syndrome, 4 vs. 2; total anomalous pulmonary venous return, 5 vs. 4; heterotaxy, 7 vs. 8), intraoperative fluid balance, or central venous pressure upon admission to the intensive care unit. Epoch 2 had a significantly shorter duration of postoperative intubation [7.2 (3.7-49) vs. 3.5 (3.0-4.6) hours, p = 0.033], pleural drainage [23 (13-34) vs. 9.5 (8.3-18) days, p = 0.007], and postoperative hospitalization [36 (29-49) vs. 27 (22-36) days, p = 0.017]. Two patients in Epoch 1 (8.3%), but none in Epoch 2, required re-intubation. Our results suggest that HFNC-iNO therapy reduces the duration of postoperative intubation, pleural drainage, and hospitalization.
2014年，我院对接受Fontan手术且血流动力学不稳定的患者在拔管后采用吸入一氧化氮（iNO）疗法联合高流量鼻导管（HFNC）氧疗。我们报告了HFNC-iNO疗法对这些患者的益处。这是一项单中心回顾性研究，纳入了2010年1月至2016年6月期间接受Fontan手术且拔管前需要iNO治疗的38例患者。患者分为两组：第1阶段（n = 24）的患者于2010年1月至2013年12月接受治疗，仅接受iNO治疗；第2阶段（n = 14）的患者于2014年1月至2016年6月接受治疗，拔管后接受iNO治疗及额外的HFNC-iNO治疗。第1阶段和第2阶段在术前心功能、手术年龄、体重、初始诊断（左心发育不全综合征，4例对2例；完全性肺静脉异位引流，5例对4例；内脏异位，7例对8例）、术中液体平衡或入住重症监护病房时的中心静脉压方面无显著差异。第2阶段术后插管时间显著缩短[7.2（3.7 - 49）小时对3.5（3.0 - 4.6）小时，p = 0.033]，胸腔引流时间[23（13 - 34）天对9.5（8.3 -
18）天，p = 0.007]，以及术后住院时间[36（29 - 49）天对27（22 - 36）天，p = 0.017]。第1阶段有2例患者（8.3%）需要再次插管，而第2阶段无患者需要再次插管。我们的结果表明，HFNC-iNO疗法可缩短术后插管、胸腔引流和住院时间。
