Cueto E, López-Herce J, Sánchez A, Carrillo A
Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Madrid, Spain.
Acta Paediatr. 1997 Dec;86(12):1337-9. doi: 10.1111/j.1651-2227.1997.tb14909.x.
We treated 40 children, aged between 15 d and 17 y, diagnosed with acute respiratory distress syndrome and/or pulmonary hypertension, with inhaled nitric oxide. The most frequent underlying diagnosis associated with ARDS were bronchopneumonia (eight), cardiac surgery (five), and sepsis (three). Pulmonary hypertension was secondary to cardiomyopathy in 2 patients and occurred in the postoperative period of cardiac surgery in 17 patients--the most frequent were ventricular septal defect (5), transposition of great arteries (4), and atrioventricular septal defect (3). In 11 patients, sudden discontinuation of nitric oxide induced a decrease in oxygenation associated in some of the patients with an increase in pulmonary artery pressure. In two patients discontinuation of nitric oxide induced severe pulmonary hypertension, extreme bradycardia and hypoxaemia, which required cardiopulmonary resuscitation. When exogenous nitric oxide is abruptly interrupted, hypoxaemia and pulmonary hypertension are found in some patients, due to a decrease in the nitric oxide concentration in the pulmonary circulation. This may be caused by the exogenous nitric oxide administration that may have inhibited endogenous production. We recommend making a progressive withdrawal of inhaled nitric oxide to avoid the side effects observed in the sudden discontinuation.
我们对40名年龄在15天至17岁之间、被诊断为急性呼吸窘迫综合征和/或肺动脉高压的儿童使用吸入一氧化氮进行治疗。与急性呼吸窘迫综合征相关的最常见潜在诊断为支气管肺炎（8例）、心脏手术（5例）和败血症（3例）。2例肺动脉高压继发于心肌病，17例发生于心脏手术后——最常见的是室间隔缺损（5例）、大动脉转位（4例）和房室间隔缺损（3例）。11例患者中，突然停用一氧化氮导致氧合下降，部分患者伴有肺动脉压升高。2例患者停用一氧化氮后出现严重肺动脉高压、极度心动过缓和低氧血症，需要进行心肺复苏。当外源性一氧化氮突然中断时，由于肺循环中一氧化氮浓度降低，部分患者会出现低氧血症和肺动脉高压。这可能是由于外源性一氧化氮给药可能抑制了内源性生成所致。我们建议逐渐停用吸入一氧化氮，以避免突然停药时出现的副作用。
