Division of Pediatric Cardiothoracic Surgery, Advocate Children's Hospital Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA.
Advocate Children's Hospital Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA.
World J Pediatr Congenit Heart Surg. 2020 Jul;11(4):417-423. doi: 10.1177/2150135120911034.
Nitric oxide (NO) plays several protective roles in ischemia/reperfusion (I/R) injury. Neonates undergoing the Norwood procedure are subject to develop I/R injury due to the immaturity of their organs and the potential need to interrupt or decrease systemic flow during surgery. We hypothesized that NO administration during cardiopulmonary bypass (CPB) ameliorates the I/R and could help the postoperative recovery after the Norwood procedure.
Twenty-four neonates who underwent a Norwood procedure were enrolled in a prospective randomized blinded controlled trial to receive NO (12 patients) or placebo (12 patients) into the oxygenator of the CPB circuit during the Norwood procedure. Markers of I/R injury were collected at baseline (T0), after weaning from CPB before modified ultrafiltration (T1), after modified ultrafiltration (T2), and at 12 hours (T3) and 24 hours (T4) after surgery, and they were compared between both groups, as well as other postoperative clinical variables.
There was no difference in age, weight, anatomical diagnosis, CPB, and aortic cross-clamp time between both groups. Troponin levels were lower in the study group at T1 (0.62 ± 58 ng/mL vs 0.87 ± 0.58 ng/mL, = .31) and became significantly lower at T2 (0.36 ± 0.32 ng/mL vs 0.97 ± 0.48 ng/mL, = .009).There were no significant differences between both groups for all other markers. Despite a lower troponin level, there was no difference in inotropic scores or ventricular function between both groups. Time to start diuresis, time to sternal closure and extubation, and intensive care unit and hospital stay were not different between both groups.
Systemic administration of NO during the Norwood procedure has myocardial protective effects (lower Troponin levels) but we observed no effect on postoperative recovery. Larger sample size may be needed to show clinical differences.
一氧化氮（NO）在缺血/再灌注（I/R）损伤中发挥多种保护作用。接受诺伍德手术的新生儿由于其器官未成熟以及手术过程中可能需要中断或减少全身血流，因此易发生 I/R 损伤。我们假设在体外循环（CPB）期间给予 NO 可以改善 I/R，并有助于诺伍德手术后的恢复。
24 名接受诺伍德手术的新生儿参与了一项前瞻性随机对照双盲临床试验，在诺伍德手术期间将 NO（12 名患者）或安慰剂（12 名患者）加入 CPB 回路中的氧合器中。在基线（T0）、从 CPB 脱机后在改良超滤前（T1）、改良超滤后（T2）以及手术后 12 小时（T3）和 24 小时（T4）收集 I/R 损伤标志物，并在两组之间进行比较，以及其他术后临床变量。
两组之间的年龄、体重、解剖诊断、CPB 和主动脉阻断时间无差异。研究组 T1 时肌钙蛋白水平较低（0.62±58ng/mL 比 0.87±0.58ng/mL， =.31），T2 时显著降低（0.36±0.32ng/mL 比 0.97±0.48ng/mL， =.009）。两组之间其他标志物均无显著差异。尽管肌钙蛋白水平较低，但两组之间的正性肌力评分或心室功能无差异。两组之间开始利尿、胸骨闭合和拔管、重症监护病房和住院时间无差异。
诺伍德手术期间全身给予 NO 具有心肌保护作用（肌钙蛋白水平较低），但我们未观察到对术后恢复的影响。可能需要更大的样本量才能显示出临床差异。
