al-Alaiyan S, al-Omran A, Dyer D
Department of Pediatrics (MBC 58), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
Intensive Care Med. 1996 Oct;22(10):1093-5.
A full-term, male neonate developed persistent pulmonary hypertension, and responded to high-frequency oscillatory ventilation and inhaled nitric oxide (INO). Discontinuation of INO was attempted three times and was followed by severe desaturations due to right-to-left shunt through the patent ductus arteriosus and patent foramen ovale. As a result of this rebound pulmonary hypertension, the neonate was maintained on INO therapy for 6 days. Successful discontinuation was achieved by using the phosphodiesterase inhibitor, dipyridamole. We speculate that during exogenous INO therapy, endogenous nitric oxide was inhibited, thus cyclic guanosine 3',5'-monophophate, the smooth muscle relaxant, was rapidly hydrolyzed. By inhibiting phosphodiesterase, smooth muscle relaxation occurred, and consequently weaning from INO was achieved.
一名足月男婴出现持续性肺动脉高压，对高频振荡通气和吸入一氧化氮（INO）治疗有反应。尝试停用INO三次，每次停用后均因动脉导管未闭和卵圆孔未闭导致右向左分流而出现严重的血氧饱和度下降。由于这种反弹性肺动脉高压，该新生儿接受INO治疗6天。通过使用磷酸二酯酶抑制剂双嘧达莫成功实现了INO的停用。我们推测，在外源性INO治疗期间，内源性一氧化氮受到抑制，因此平滑肌松弛剂环磷酸鸟苷迅速水解。通过抑制磷酸二酯酶，平滑肌松弛得以发生，从而实现了INO的撤机。
