Date H, Triantafillou A N, Trulock E P, Pohl M S, Cooper J D, Patterson G A
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Thorac Cardiovasc Surg. 1996 May;111(5):913-9. doi: 10.1016/s0022-5223(96)70364-1.
Early severe graft dysfunction, as manifested by hypoxia and pulmonary hypertension, occurs in 10% to 20% of lung transplant recipients. We retrospectively investigated whether inhaled nitric oxide would reduce human lung allograft dysfunction by comparing postoperative hemodynamic data, gas exchange, and outcome in lung transplant recipients with early graft dysfunction treated with or without nitric oxide.
Among 243 adult lung transplant procedures, there were 32 patients (13.2%) in whom immediate severe allograft dysfunction developed (arterial oxygen tension/inspired oxygen concentration ratio <150). Group 1 (n = 17) included patients who underwent transplantation before nitric oxide became available in our center and were treated conventionally. Group 2 (n = 15) included those treated with nitric oxide as soon as severe allograft dysfunction was diagnosed. Duration of nitric oxide therapy (20 to 60 ppm) was 15 to 217 hours (average 84 hours).
In group 2, nitric oxide lowered mean pulmonary artery pressure from 30 +/- 2 to 26 +/- 2 mm Hg (p < 0.05), improved the ratio of arterial oxygen tension to inspired oxygen fraction from 88 +/- 10 to 153 +/- 30 (p < 0.05) within 1 hour, and caused a sustained improvement in these parameters during extended therapy. Mean arterial pressure and cardiac index were unchanged during nitric oxide therapy. Transient methemoglobinemia (>6%) developed in two patients. However, no complications were associated with nitric oxide use. Duration of mechanical ventilation was 17 +/- 5 days in group 1 and 12 +/- 3 days in group 2. Four patients had airway complications in group 1, whereas no airway complication was encountered in group 2. Mortality was 24% (4/17) in group 1 and 7% (1/15) in group 2.
Nitric oxide improves oxygenation and decreases pulmonary artery pressure without systemic circulatory effects in patients with severe allograft dysfunction. Furthermore, in these patients, nitric oxide may shorten postoperative mechanical ventilation time and reduce airway complications and mortality.
早期严重移植肺功能障碍表现为低氧血症和肺动脉高压，见于10%至20%的肺移植受者。我们通过比较接受或未接受一氧化氮治疗的早期移植肺功能障碍肺移植受者的术后血流动力学数据、气体交换和转归，回顾性研究吸入一氧化氮是否会减轻人肺移植功能障碍。
在243例成人肺移植手术中，有32例患者（13.2%）出现即刻严重移植肺功能障碍（动脉血氧分压/吸入氧浓度比值<150）。第1组（n = 17）包括在我们中心一氧化氮可用之前接受移植并接受常规治疗的患者。第2组（n = 15）包括一旦诊断出严重移植肺功能障碍就接受一氧化氮治疗的患者。一氧化氮治疗持续时间（20至60 ppm）为15至217小时（平均84小时）。
在第2组中，一氧化氮使平均肺动脉压从30±2降至26±2 mmHg（p < 0.05），在1小时内使动脉血氧分压与吸入氧分数的比值从88±10提高到153±30（p < 0.05），并在延长治疗期间使这些参数持续改善。一氧化氮治疗期间平均动脉压和心脏指数未改变。两名患者出现短暂性高铁血红蛋白血症（>6%）。然而，使用一氧化氮未出现并发症。第1组机械通气时间为17±5天，第2组为12±3天。第1组有4例患者出现气道并发症，而第2组未遇到气道并发症。第1组死亡率为24%（4/17），第2组为7%（1/15）。
对于严重移植肺功能障碍患者，一氧化氮可改善氧合并降低肺动脉压，而无全身循环效应。此外，对于这些患者，一氧化氮可能缩短术后机械通气时间，减少气道并发症和死亡率。
