Fontan类手术和双向格林吻合术后严重肺灌注患者吸入一氧化氮的情况。

Inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis.

作者信息

Gamillscheg A, Zobel G, Urlesberger B, Berger J, Dacar D, Stein J I, Rigler B, Metzler H, Beitzke A

机构信息

Department of Pediatric Cardiology, University of Graz, Austria.

出版信息

J Thorac Cardiovasc Surg. 1997 Mar;113(3):435-42. doi: 10.1016/S0022-5223(97)70355-6.

DOI:10.1016/S0022-5223(97)70355-6

PMID:9081087

Abstract

OBJECTIVE

The aim of this study was to evaluate the effects of inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis.

METHODS

Inhaled nitric oxide (mean 4.1 +/- 0.7 ppm, 1.5 to 10 ppm) was administered in 13 patients (mean age 5.6 +/- 1.6 years, 1.5 to 17 years) with critical pulmonary perfusion (central venous pressure > 20 mm Hg or transpulmonary pressure gradient > 10 mm Hg) in the early postoperative period after total cavopulmonary connection (n = 9) or after bidirectional Glenn anastomosis (n = 4).

RESULTS

In patients after total cavopulmonary connection inhaled nitric oxide therapy decreased central venous pressure by 15.3% +/- 1.4% (p = 0.0001) and transpulmonary pressure gradient by 42% +/- 8% (p = 0.0008) and increased mean systemic arterial and left atrial pressures by 12% +/- 3.6% (p = 0.011) and 28% +/- 8% (p = 0.007), respectively. Arterial and venous oxygen saturations improved by 8.2% +/- 1% (p = 0.005) and 14% +/- 4.3% (p = 0.03), respectively. In patients after bidirectional Glenn anastomosis inhaled nitric oxide therapy resulted in a decrease of central venous pressure by 22% +/- 1% and of the transpulmonary pressure gradient by 55% +/- 6% and improved arterial and venous oxygen saturations by 37% +/- 29% and 11% +/- 3%, respectively. Mean systemic arterial and left atrial pressures remained nearly unchanged. No toxic side effect was observed in any patient.

CONCLUSION

Inhaled nitric oxide may play an important role in the management of transient critical pulmonary perfusion caused by reactive elevated pulmonary vascular resistance in the early postoperative period after Fontan-type operations and bidirectional Glenn anastomosis.

摘要

目的

本研究旨在评估吸入一氧化氮对接受Fontan类手术和双向格林吻合术后出现严重肺灌注问题患者的影响。

方法

对13例（平均年龄5.6±1.6岁，1.5至17岁）在全腔静脉肺动脉连接术（n = 9）或双向格林吻合术（n = 4）术后早期出现严重肺灌注（中心静脉压>20 mmHg或跨肺压梯度>10 mmHg）的患者给予吸入一氧化氮（平均4.1±0.7 ppm，1.5至10 ppm）治疗。

结果

在接受全腔静脉肺动脉连接术的患者中，吸入一氧化氮治疗使中心静脉压降低了15.3%±1.4%（p = 0.0001），跨肺压梯度降低了42%±8%（p = 0.0008），平均体循环动脉压和左心房压分别升高了12%±3.6%（p = 0.011）和28%±8%（p = 0.007）。动脉血氧饱和度和静脉血氧饱和度分别提高了8.2%±1%（p = 0.005）和14%±4.3%（p = 0.03）。在接受双向格林吻合术的患者中，吸入一氧化氮治疗使中心静脉压降低了22%±1%，跨肺压梯度降低了55%±6%，动脉血氧饱和度和静脉血氧饱和度分别提高了37%±29%和11%±3%。平均体循环动脉压和左心房压几乎保持不变。未观察到任何患者出现毒性副作用。