肝移植期间及术后吸入一氧化氮对1型严重肝肺综合征患儿低氧血症的逆转作用。
Reversal of hypoxemia by inhaled nitric oxide in children with severe hepatopulmonary syndrome, type 1, during and after liver transplantation.
作者信息
Durand P, Baujard C, Grosse A L, Gomola A, Debray D, Dousset B, Devictor D
机构信息
Unité de Réanimation Pédiatrique Polyvalente, Hôpital de Bicêtre, Paris, France.
出版信息
Transplantation. 1998 Feb 15;65(3):437-9. doi: 10.1097/00007890-199802150-00026.
BACKGROUND
The hepatopulmonary syndrome with profound hypoxemia is a rare but severe complication for children with liver cirrhosis. It can be reversed by liver transplantation (LT), which is now regarded as a good indication. However, previous reports have described cases of transient or fatal deteriorations of intrapulmonary shunting after pediatric liver transplantation with dramatically worsening hypoxemia.
METHODS AND RESULTS
A similar case during and after LT in a 4-year-old girl with severe hepatopulmonary syndrome is described with prompt reversal of hypoxemia by inhaled nitric oxide, which was discontinued definitely until day 14 after LT.
CONCLUSIONS
During or after LT, worsening hypoxemia may be improved by using inhaled nitric oxide in pediatric patients undergoing liver transplantation for liver cirrhosis and hepatopulmonary syndrome. The mechanisms are unclear, but may involve mismatching lung ventilation-perfusion. However, additional clinical reports are necessary before accepting these results.
背景
严重低氧血症的肝肺综合征是肝硬化儿童罕见但严重的并发症。肝移植（LT）可使其逆转，目前被视为良好的适应证。然而，既往报道描述了小儿肝移植后肺内分流出现短暂或致命性恶化、低氧血症显著加重的病例。
方法与结果
描述了一名患有严重肝肺综合征的4岁女孩在肝移植期间及术后出现的类似病例，吸入一氧化氮使低氧血症迅速逆转，该治疗在肝移植后第14天前完全停用。
结论
对于因肝硬化和肝肺综合征接受肝移植的儿科患者，在肝移植期间或术后，使用吸入一氧化氮可能改善恶化的低氧血症。其机制尚不清楚，但可能涉及肺通气-灌注不匹配。然而，在接受这些结果之前，还需要更多的临床报告。
Zotero 插件