Chang J C, Sawa Y, Ohtake S, Fukushima N, Nishimura M, Kagizaki K, Ohata T, Yamaguchi T, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
ASAIO J. 1997 Sep-Oct;43(5):M418-21.
Recently it has been shown that inhaled nitric oxide (NO), which has been proven to contribute to improvement in critical pulmonary hypertension, may provide a favorable effect early after left ventricular assist device (LVAD) support. To improve right ventricular function, inhalation of NO was added to treatment with conventional catecholamines for four consecutive dilated cardiomyopathy (DCM) patients following institution of LVAD. In two patients 1 hr after inhalation of NO, central venous pressure (CVP), mean pulmonary arterial pressure (PAm), and pulmonary vascular resistance (PVR) were improved. These results led to better LVAD output and resulted in an adequate cardiac index. On the other hand, a right VAD (RVAD) was implemented in one patient whose high CVP, PAm, and PVR continued; he was weaned after 8 days of RVAD support. Another patient who had a high CVP but normal PAm and PVR before and after inhalation of NO had no improvement in his hemodynamic state. These data suggest that inhaled NO may improve systemic circulation by reducing right ventricular afterload and may become a promising and convenient therapy before placing RVAD in DCM patients under LVAD support. RVAD should be conducted in patients with right ventricular failure or when pulmonary hypertension is associated with impaired right ventricular reserve, even after inhalation of NO.
最近的研究表明，吸入一氧化氮（NO）已被证明有助于改善严重肺动脉高压，可能在左心室辅助装置（LVAD）支持后早期产生有益效果。为改善右心室功能，对4例扩张型心肌病（DCM）患者在植入LVAD后，在常规儿茶酚胺治疗的基础上加用吸入NO进行连续治疗。在2例患者吸入NO 1小时后，中心静脉压（CVP）、平均肺动脉压（PAm）和肺血管阻力（PVR）均得到改善。这些结果使LVAD输出增加，心脏指数适当。另一方面，1例CVP、PAm和PVR持续升高的患者植入了右心室辅助装置（RVAD）；在RVAD支持8天后撤离。另1例患者在吸入NO前后CVP高但PAm和PVR正常，其血流动力学状态无改善。这些数据表明，吸入NO可能通过降低右心室后负荷来改善体循环，并且可能成为在LVAD支持下的DCM患者植入RVAD之前一种有前景且便捷的治疗方法。对于右心室衰竭或即使吸入NO后肺动脉高压仍伴有右心室储备功能受损的患者，应进行RVAD植入。
