Auler Júnior J O, Carmona M J, Bocchi E A, Bacal F, Fiorelli A I, Stolf N A, Jatene A D
Cardiopulmonary and Anesthesia Department, Instituto do Coraçäo, Hospital das Clinicas, Universidade de Säo Paulo, Brazil.
J Heart Lung Transplant. 1996 May;15(5):443-50.
The purpose of this study was to assess the hemodynamic effects of low doses of inhaled nitric oxide in patients after orthotopic heart transplantation.
Two hours after the operation 10 adult patients who were still under anesthetic effects and undergoing mechanical ventilation inhaled, during 60 minutes, a mixture of nitrogen, oxygen, and nitric oxide (20 ppm). A standard profile of hemodynamic data was collected at baseline, at 30 minutes, at 30 more minutes of inhalation, and at the same points after nitric oxide suspension.
A significant decrease was found from baseline to 60 minutes, immediately after nitric oxide inhalation in the following: systemic vascular resistance index 1268 +/- 409 to 1090 +/- 354 (p = 0.0161); pulmonary vascular resistance index 252 +/- 124 to 154 +/- 98 (p < 0.05); pulmonary vascular resistance index/systemic vascular resistance index ratio 0.21 +/- 0.09 to 0.14 +/- 0.08 (p = 0.0025); transpulmonary gradient 12 +/- 3 to 9 +/- 3 (p = 0.05). A significant increase was also found in cardiac index from 4.2 +/- 1.1 to 4.9 +/- 1.4 (p = 0.0007). Other parameters such as mean pulmonary, systemic, wedge and right atrial pressures, in addition to intrapulmonary shunting, heart rate, and oxygen extraction ratio, did not present any significant changes. The procedure was well tolerated by all patients, and no undesirable effects such as methemoglobin elevation or worsening of pulmonary hypertension after nitric oxide suspension were observed.
The beneficial effects observed by inhaled nitric oxide in the pulmonary vascular resistance index/systemic vascular resistance index ratio, transpulmonary gradient, and cardiac index suggest that nitric oxide acts mainly in pulmonary territory and could be a possible pulmonary vasodilator agent used to control central hemodynamics after heart transplantation.
本研究旨在评估低剂量吸入一氧化氮对原位心脏移植术后患者的血流动力学影响。
10例仍处于麻醉状态且接受机械通气的成年患者在术后2小时吸入含氮、氧和一氧化氮（20 ppm）的混合气体60分钟。在基线、30分钟、吸入30分钟后以及一氧化氮吸入停止后的相同时间点收集标准的血流动力学数据。
一氧化氮吸入后立即从基线到60分钟，以下指标显著下降：全身血管阻力指数从1268±409降至1090±354（p = 0.0161）；肺血管阻力指数从252±124降至154±98（p < 0.05）；肺血管阻力指数/全身血管阻力指数比值从0.21±0.09降至0.14±0.08（p = 0.0025）；跨肺压差从12±3降至9±3（p = 0.05）。心脏指数也显著升高，从4.2±1.1升至4.9±1.4（p = 0.0007）。其他参数，如平均肺动脉压、体循环压、楔压和右心房压，以及肺内分流、心率和氧摄取率，均未出现任何显著变化。所有患者对该操作耐受性良好，未观察到诸如高铁血红蛋白升高或一氧化氮吸入停止后肺动脉高压恶化等不良影响。
吸入一氧化氮在肺血管阻力指数/全身血管阻力指数比值、跨肺压差和心脏指数方面观察到的有益作用表明，一氧化氮主要作用于肺部，可能是心脏移植后用于控制中心血流动力学的一种潜在肺血管扩张剂。
