Curran R D, Mavroudis C, Backer C L, Sautel M, Zales V R, Wessel D L
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
Ann Thorac Surg. 1995 Dec;60(6):1765-71. doi: 10.1016/0003-4975(95)00812-8.
Endothelium-derived nitric oxide (NO) is a potent vasodilator and a major mediator of pulmonary vascular tone.
Five infants underwent a trial of inhaled NO with hemodynamic monitoring in the operating room after atrioventricular canal repair. An additional 15 patients with congenital heart disease and refractory pulmonary hypertension were treated with inhaled NO for 1 day to 10 days postoperatively.
In the 5 infants with atrioventricular canal, corrective surgical intervention and conventional therapy (hyperventilation, inspired oxygen fraction of 0.80, and inotropic agents) lowered mean pulmonary artery pressure from 49.5 +/- 10.5 to 20.0 +/- 2.2 mm Hg (p < 0.001). Adding inhaled NO further decreased mean pulmonary artery pressure to 18.0 +/- 2.8 mm Hg (p = not significant). Inhaled NO had no effect on ventricular function curves (inflow occlusion) in this group. In the 15 patients with refractory postoperative pulmonary hypertension, 11 had a favorable response to inhaled NO, with a decrease in mean pulmonary artery pressure from 30.9 +/- 5.8 to 23.1 +/- 5.4 mm Hg (p < 0.01) in 8 patients with pulmonary artery catheters.
These studies demonstrate that inhaled NO has minimal beneficial effect on pulmonary artery pressure or cardiac output in infants after repair of atrioventricular canal. Inhaled NO is effective in decreasing PAP postoperatively in select patients with congenital heart disease and pulmonary hypertension refractory to conventional therapeutic modalities.
内皮源性一氧化氮（NO）是一种强效血管舒张剂，也是肺血管张力的主要调节因子。
5例婴儿在房室管修复术后于手术室接受吸入一氧化氮试验并进行血流动力学监测。另外15例先天性心脏病合并难治性肺动脉高压患者在术后接受1天至10天的吸入一氧化氮治疗。
在5例房室管婴儿中，矫正性手术干预和传统治疗（过度通气、吸入氧分数0.80及正性肌力药物）使平均肺动脉压从49.5±10.5降至20.0±2.2 mmHg（p<0.001）。加用吸入一氧化氮后平均肺动脉压进一步降至18.0±2.8 mmHg（p无统计学意义）。吸入一氧化氮对该组心室功能曲线（流入道阻断）无影响。在15例术后难治性肺动脉高压患者中，11例对吸入一氧化氮有良好反应，8例有肺动脉导管的患者平均肺动脉压从30.9±5.8降至23.1±5.4 mmHg（p<0.01）。
这些研究表明，吸入一氧化氮对房室管修复术后婴儿的肺动脉压或心输出量的有益作用极小。吸入一氧化氮对某些先天性心脏病合并传统治疗方式难治的肺动脉高压患者术后降低肺动脉压有效。
