Winberg P, Lundell B P, Gustafsson L E
Department of Paediatrics, St Göran's Children's Hospital, Karolinska Institute, Stockholm, Sweden.
Br Heart J. 1994 Mar;71(3):282-6. doi: 10.1136/hrt.71.3.282.
To study the short-term effects of inhaled nitric oxide in infants and young children with congenital heart disease.
A supraregional referral centre for children with congenital heart disease.
22 infants and children aged 3-32 months (median age 5 months) with congenital heart disease undergoing preoperative cardiac catheterisation. All but one infant had intracardiac shunt lesions and 13 had increased pulmonary vascular resistance. During catheterisation the patients inhaled nitric oxide in a concentration of 40 parts per million in room air. Pulmonary and systemic haemodynamic variables were evaluated by means of measured oxygen consumption and the Fick principle before and after 10 minutes' exposure to nitric oxide.
Inhaled nitric oxide did not affect the systemic circulation. There was a significant reduction in the pulmonary vascular resistance, but only in the 13 infants with pulmonary hypertension, in whom pulmonary vascular resistance was reduced by 34% from 8.6 (4.6) mm Hg.min.m2.l-1 (mean (SD)) to 5.7 (3.5) mm Hg.min.m2.l-1. The pulmonary circulation in infants with normal pulmonary vascular resistance was not affected. No statistically significant increase in methaemoglobin was seen, though there were large individual differences. No other side effects were seen.
The present study shows that in infants with congenital heart disease inhaled nitric oxide reduced pathologically increased pulmonary vascular resistance without affecting systemic circulation and without important side effects with brief exposure.
研究吸入一氧化氮对患有先天性心脏病的婴幼儿的短期影响。
一家先天性心脏病患儿的区域转诊中心。
22名年龄在3至32个月（中位年龄5个月）的患有先天性心脏病且正在接受术前心导管检查的婴幼儿。除一名婴儿外，所有婴儿均患有心内分流病变，其中13名婴儿的肺血管阻力增加。在导管检查期间，患者吸入浓度为百万分之40的一氧化氮与室内空气的混合气。在接触一氧化氮10分钟前后，通过测量耗氧量和运用Fick原理评估肺和体循环的血流动力学变量。
吸入一氧化氮未影响体循环。肺血管阻力显著降低，但仅在13名患有肺动脉高压的婴儿中出现，其肺血管阻力从8.6（4.6）mmHg·min·m²·l⁻¹（均值（标准差））降至5.7（3.5）mmHg·min·m²·l⁻¹，降低了34%。肺血管阻力正常的婴儿的肺循环未受影响。虽然个体差异较大，但未观察到高铁血红蛋白有统计学意义的增加。未观察到其他副作用。
本研究表明，对于患有先天性心脏病的婴儿，吸入一氧化氮可降低病理性升高的肺血管阻力，且在短时间接触时不影响体循环，也无重要副作用。
