Goldman A P, Delius R E, Deanfield J E, Macrae D J
Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
Ann Thorac Surg. 1995 Aug;60(2):300-5; discussion 306. doi: 10.1016/0003-4975(95)00408-d.
Severe pulmonary hypertension is still a cause of morbidity and mortality in children after cardiac operations. The objective of this study was to compare the vasodilator properties of inhaled nitric oxide, a novel pulmonary vasodilator, and intravenous prostacyclin in the treatment of severe postoperative pulmonary hypertension.
Thirteen children (aged 3 days to 12 months) with severe pulmonary hypertension after cardiac operations were given inhaled nitric oxide (20 ppm x 10 minutes) and intravenous prostacyclin (20 ng.kg-1.min-1 x 10 minutes) in a prospective, randomized cross-over study.
Both nitric oxide and prostacyclin resulted in a reduction in pulmonary arterial pressure, although the mean pulmonary arterial pressure was significantly lower during nitric oxide therapy (28.5 +/- 2.9 mm Hg) than during prostacyclin therapy (35.4 +/- 2.1 mm Hg; p < 0.05). The mean pulmonary to systemic arterial pressure ratio was also significantly lower during nitric oxide than prostacylin administration (0.46 +/- 0.04 versus 0.68 +/- 0.05; p < 0.01), due mainly to only prostacyclin lowering systemic blood pressure.
Inhaled nitric oxide was a more effective and selective pulmonary vasodilator than prostacyclin and should be considered as the preferred treatment for severe postoperative pulmonary hypertension.
严重肺动脉高压仍是心脏手术后儿童发病和死亡的一个原因。本研究的目的是比较新型肺血管扩张剂吸入一氧化氮和静脉注射前列环素在治疗严重术后肺动脉高压方面的血管扩张特性。
在一项前瞻性、随机交叉研究中，对13例心脏手术后患有严重肺动脉高压的儿童（年龄3天至12个月）给予吸入一氧化氮（20 ppm×10分钟）和静脉注射前列环素（20 ng·kg-1·min-1×10分钟）。
一氧化氮和前列环素均导致肺动脉压降低，尽管一氧化氮治疗期间的平均肺动脉压（28.5±2.9 mmHg）显著低于前列环素治疗期间（35.4±2.1 mmHg；p<0.05）。一氧化氮给药期间的平均肺循环与体循环动脉压比值也显著低于前列环素给药期间（0.46±0.04对0.68±0.05；p<0.01），主要是因为只有前列环素降低了体循环血压。
吸入一氧化氮是一种比前列环素更有效、更具选择性的肺血管扩张剂，应被视为严重术后肺动脉高压的首选治疗方法。
