Williams R S, Mickell J J, Young E S, Shapiro J H, Lofland G K
Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond.
J Cardiothorac Vasc Anesth. 1994 Dec;8(6):658-62. doi: 10.1016/1053-0770(94)90198-8.
Nitroglycerin (NTG) and sodium nitroprusside (SNP) are routinely used perioperatively in infants with congenital heart defects. In this study, NTG and SNP were infused in the operating room to increase venous capacitance, reduce systemic and pulmonary afterload, facilitate weaning off cardiopulmonary bypass, stabilize hemodynamics for transport to the intensive care unit (ICU), and reduce the fluid resuscitation needed upon arrival in the ICU. Because of the risk for accumulation of methemoglobin (MetHb) and cyanmethemoglobin (cyan-MetHb) during prolonged continuous infusion of NTG and SNP, it was decided to (1) quantify ICU use, (2) measure % MetHb at 12-hour intervals, and (3) look indirectly for the accumulation of cyan-MetHb by comparing simultaneous pulse oximetry (SpO2) (Nellcor N-100 [Nellcor, Haywood, CO]) and CO-oximetry (SaO2) (Corning 270 [Corning, Medfield, MA]). A total of 69 arterial samples were obtained from 16 infants (median age 4.4 months) following cardiac surgery with bypass. Median doses of NTG, 6.0 mg/kg (range 0.7 to 27.5), and SNP, 3.3 mg/kg (range 0.6 to 33.4), were infused over a median of 64.5 hours (range 12 to 183) (N = 16 patients). The median MetHb was 0.6% (range 0.0 to 1.5) after infusions of NTG, 1.8 micrograms/kg/min (range 0.5 to 4), and SNP, 1.3 micrograms/kg/min (range 0.3 to 8.4) (N = 69 measurements). Regression analysis of oximetry data yielded the equation: SpO2 = 1.04 SaO2 - 3.7%, r = 0.97. The mean difference between SpO2 and SaO2 data pairs was 0.0% (bias) with a SD (precision) of +/- 2.3%.(ABSTRACT TRUNCATED AT 250 WORDS)
硝酸甘油（NTG）和硝普钠（SNP）在患有先天性心脏病的婴儿围手术期常规使用。在本研究中，NTG和SNP在手术室输注，以增加静脉容量，降低体循环和肺循环后负荷，促进脱离体外循环，稳定血流动力学以便转运至重症监护病房（ICU），并减少抵达ICU后所需的液体复苏量。由于在长时间持续输注NTG和SNP期间存在高铁血红蛋白（MetHb）和氰化高铁血红蛋白（cyan-MetHb）蓄积的风险，因此决定：（1）量化ICU使用情况；（2）每隔12小时测量MetHb百分比；（3）通过比较同步脉搏血氧饱和度（SpO2）（Nellcor N-100 [Nellcor，Haywood，科罗拉多州]）和血气血氧饱和度（SaO2）（康宁270 [康宁，Medfield，马萨诸塞州]）间接观察cyan-MetHb的蓄积情况。在16例婴儿（中位年龄4.4个月）心脏搭桥手术后共采集了69份动脉样本。NTG的中位剂量为6.0 mg/kg（范围0.7至27.5），SNP的中位剂量为3.3 mg/kg（范围0.6至33.4），输注时间中位数为64.5小时（范围12至183）（N = 16例患者）。输注NTG剂量为1.8微克/千克/分钟（范围0.5至4）和SNP剂量为1.3微克/千克/分钟（范围0.3至8.4）后，MetHb的中位数为0.6%（范围0.0至1.5）（N = 69次测量）。血氧饱和度数据的回归分析得出方程：SpO2 = 1.04 SaO2 - 3.7%，r = 0.97。SpO2和SaO2数据对之间的平均差异为0.0%（偏差），标准差（精密度）为±2.3%。（摘要截断于250字）
