Macdonald P S, Keogh A, Mundy J, Rogers P, Nicholson A, Harrison G, Jansz P, Kaan A M, Spratt P
Cardiopulmonary Transplant Unit, St. Vincent's Hospital Sydney Australia, Darlinghurst.
J Heart Lung Transplant. 1998 Mar;17(3):312-6.
The aim of this study was to evaluate the efficacy of inhaled nitric oxide in the prevention and reversal of pulmonary hypertension during and after left ventricular assist device implantation.
Inhaled nitric oxide (20 ppm) was administered to seven consecutive patients undergoing implantation of a left ventricular assist device at the time of implantation and for the first 24 hours after operation.
Withdrawal of inhaled nitric oxide at 24 hours after operation was associated with a significant rise in both the transpulmonary gradient (from 8+/-1 to 14+/-2 mm Hg, p < 0.01) and in pulmonary vascular resistance (from 110+/-19 to 196+/-32 dynes x sec x cm[-5], p < 0.01). In two patients, the rise in pulmonary vascular resistance resulted in a critical fall in left ventricular assist device flow and hemodynamic deterioration, necessitating urgent reinstitution of inhaled nitric oxide.
The administration of inhaled nitric oxide at the time of left ventricular assist device implantation prevents rises in pulmonary vascular resistance that in some patients result in critical reductions in left ventricular assist device flow. We suggest that inhaled nitric oxide is a useful adjunctive treatment that should be routinely available at the time of left ventricular assist device implantation.
本研究的目的是评估吸入一氧化氮在左心室辅助装置植入期间及之后预防和逆转肺动脉高压的疗效。
对连续7例接受左心室辅助装置植入的患者在植入时及术后头24小时给予吸入一氧化氮（20 ppm）。
术后24小时停用吸入一氧化氮与跨肺压差（从8±1 mmHg升至14±2 mmHg，p<0.01）和肺血管阻力（从110±19达因·秒·厘米⁻⁵升至196±32达因·秒·厘米⁻⁵，p<0.01）显著升高相关。在2例患者中，肺血管阻力升高导致左心室辅助装置血流量严重下降和血流动力学恶化，需要紧急重新给予吸入一氧化氮。
在左心室辅助装置植入时给予吸入一氧化氮可防止肺血管阻力升高，在某些患者中这会导致左心室辅助装置血流量严重减少。我们建议吸入一氧化氮是一种有用的辅助治疗方法，在左心室辅助装置植入时应常规使用。
