Inoue Nobuyuki, Yamamoto Nobuyuki, Ohtomo Yuki, Ohtomo Yurie, Fukunishi Takuma
Department of Cardiovascular Surgery, Hokuto Hospital, Obihiro, Japan.
Kyobu Geka. 2024 Jun;77(6):409-414.
Inhaled nitric oxide( iNO) therapy is commonly used to improve pulmonary hypertension and oxygenation in adult patients undergoing open heart surgery, mostly being applied to mechanical ventilation (MV). We often face rebound of pulmonary artery pressure (PAP) after reduction or discontinuation of iNO therapy, resulting in prolonged MV. Twenty-three cases, to which iNO therapy during MV (MV-iNO) were initiated, then continuously treated with iNO therapy using high-flow nasal cannula (HFNC-iNO) after extubation, were retrospectively investigated. During MV-iNO, mean PAP( mPAP) was significantly lower than before starting iNO therapy (p<0.001). Also, mPAP on HFNC-iNO was significantly lower than mPAP before iNO therapy during MV (p<0.001). There was no significant difference of mPAP between MV-iNO and HFNC-iNO (p=0.38). MV was discontinued in 330 minutes (median), oxygenation was maintained after switching from MV-iNO to HFNC-iNO and there were no cases of reintubation, perioperative mortality, or adverse events due to iNO therapy. HFNC-iNO is considered as useful method in maintaining decreased mPAP and improved oxygenation after extubation in adult patients after open heart surgery.
吸入一氧化氮（iNO）疗法常用于改善接受心脏直视手术的成年患者的肺动脉高压和氧合，主要应用于机械通气（MV）。我们在iNO治疗减少或停止后经常面临肺动脉压（PAP）反弹，导致机械通气时间延长。回顾性调查了23例在机械通气期间开始iNO治疗（MV-iNO），然后在拔管后使用高流量鼻导管持续iNO治疗（HFNC-iNO）的病例。在MV-iNO期间，平均肺动脉压（mPAP）显著低于开始iNO治疗前（p<0.001）。此外，HFNC-iNO时的mPAP显著低于MV期间iNO治疗前的mPAP（p<0.001）。MV-iNO和HFNC-iNO之间的mPAP无显著差异（p=0.38）。机械通气在330分钟（中位数）时停止，从MV-iNO转换为HFNC-iNO后氧合得以维持，且没有再次插管、围手术期死亡或因iNO治疗导致不良事件的病例。HFNC-iNO被认为是维持心脏直视手术后成年患者拔管后mPAP降低和氧合改善的有用方法。
