Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Comput Math Methods Med. 2022 Mar 22;2022:9612548. doi: 10.1155/2022/9612548. eCollection 2022.
To investigate the differences between inhaled nitric oxide (iNO) treatment and conventional therapy in the treatment of postoperative hypoxemia in obese patients with acute type A aortic dissection (ATAAD).
ATAAD patients diagnosed and treated with emergency surgery in our hospital from June 2017 to December 2019 were retrospectively analyzed. Patients with postoperative hypoxemia were divided into the iNO group and control group. Propensity score matching was used to analyze clinical characteristics and results of the two groups.
A total of 218 ATAAD patients with BMI ≥ 25 were treated with surgery. Among them, 115 patients developed refractory hypoxemia (64 in the control group and 51 in the iNO group). Patients in the iNO group had significantly shorter invasive mechanical ventilation time, intensive care unit (ICU) stay, and hospital stay. After 6 h of iNO treatment, the PaO/FiO ratio in the iNO group increased significantly, and this ratio was higher than that in the control group at 6, 12, 24, 48, and 72 h after treatment.
Low-dose iNO could improve oxygenation and shorten mechanical ventilation and ICU stay in patients with hypoxemia after ATAAD surgery, but without significant side effects or increase in postoperative mortality or morbidity. These findings provide a basis for a randomized multicenter controlled trial to assess the efficacy of iNO in the treatment of hypoxemia after ATAAD surgery.
研究吸入一氧化氮（iNO）治疗与常规治疗在肥胖急性 A 型主动脉夹层（ATAAD）术后低氧血症患者中的差异。
回顾性分析 2017 年 6 月至 2019 年 12 月我院因急诊手术诊断和治疗的 ATAAD 患者。将术后低氧血症患者分为 iNO 组和对照组。采用倾向性评分匹配分析两组的临床特征和结果。
共 218 例 BMI≥25 的 ATAAD 患者接受手术治疗。其中 115 例出现难治性低氧血症（对照组 64 例，iNO 组 51 例）。iNO 组患者的有创机械通气时间、重症监护病房（ICU）入住时间和住院时间明显缩短。iNO 治疗 6 h 后，iNO 组患者的 PaO/FiO 比值明显升高，且在治疗后 6、12、24、48 和 72 h 时，该比值均高于对照组。
小剂量 iNO 可改善 ATAAD 术后低氧血症患者的氧合，缩短机械通气和 ICU 入住时间，但无明显副作用，也不会增加术后死亡率或发病率。这些发现为评估 iNO 治疗 ATAAD 术后低氧血症的疗效的随机多中心对照试验提供了依据。
