Professor, Department of Anesthesiology, Resuscitation and Emergency Medical Aid; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
PhD Student, Department of Anesthesiology, Resuscitation and Emergency Medical Aid; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
Sovrem Tekhnologii Med. 2021;12(5):28-34. doi: 10.17691/stm2020.12.5.03. Epub 2020 Oct 28.
was to evaluate the effectiveness of a new technology for the use of inhaled nitric oxide (NO) for the heart and lung protection during operations with cardiopulmonary bypass (СРВ).
The study included 90 patients who underwent heart valve surgery and combined procedures under CPB and pharmacological cardioplegia. Three groups were created: group 1 (control, n=30); group 2 (n=30) - NO inhalation (20 ppm) was conducted traditionally, that is, before and after CPB; group 3 (n=30) - NO inhalation was performed using a new technology - during the entire operation, with pulmonary artery perfusion and lung ventilation performed during CPB. Troponin I (cTn I) level, changes in the pulmonary function parameters, and clinical indicators were studied.
Statistically significant lower levels of postoperative cTn I were registered in the patients of groups 2 and 3, at the same time, the levels were significantly lower in group 3 compared to group 2. The patients in group 1 (standardized anesthesia protocol) demonstrated an increase in the alveolar-arterial oxygen difference, an increase in intrapulmonary shunting, a decrease in blood oxygenation, and static lung compliance after СРВ. In both cases, NO inhalation retained the values of lung compliance and pulmonary oxygenating function after CPB, and in the patients of group 3, it also significantly reduced intrapulmonary shunting and alveolar-arterial difference after CPB. NO inhalation allowed a statistically significant decrease in the incidence of pulmonary dysfunction, acute respiratory failure, as well as the time of respiratory support in the ICU.
The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.
评估心肺转流术（CPB）期间吸入一氧化氮（NO）用于心脏和肺保护的新技术的有效性。
本研究纳入了 90 例行 CPB 及药物停搏下心瓣膜手术和联合手术的患者。创建了 3 个组：组 1（对照组，n=30）；组 2（n=30）- 传统方式吸入 NO（20ppm），即在 CPB 前后进行；组 3（n=30）- 使用新技术进行 NO 吸入，即在 CPB 期间持续进行，同时进行肺动脉灌注和肺通气。研究了肌钙蛋白 I（cTn I）水平、肺功能参数变化和临床指标。
组 2 和 3 的术后 cTn I 水平显著降低，同时组 3 明显低于组 2。组 1（标准化麻醉方案）的患者在 CPB 后肺泡-动脉氧差增加、肺内分流增加、血氧降低、静态肺顺应性降低。在这两种情况下，NO 吸入均能维持 CPB 后肺顺应性和肺氧合功能，而组 3 的患者在 CPB 后也显著降低了肺内分流和肺泡-动脉差。NO 吸入可显著降低肺功能障碍、急性呼吸衰竭的发生率以及 ICU 中呼吸支持的时间。
CPB 手术中使用吸入 NO 的新技术可显著改善心肺保护作用。NO 保护作用的有效性取决于其给药时间，在整个手术期间（包括 CPB 时间）使用时效果最明显。
