雾化吸入硝酸甘油对先天性心脏病并肺动脉高压患儿血流动力学的影响  

Effect of nebulized nitroglycerin inhalation on hemodynamics in children with pulmonary hypertension secondary to congenital heart disease

作　　者：范瑾[1] 杜军保[1] 何晓菊[1] 李源[1] 刘雪芹[1] 李万镇[1] 唐朝枢[2] 

机构地区：[1]北京大学第一医院儿科,100034 [2]北京大学第一医院心血管病研究所,100034

出　　处：《实用儿科临床杂志》2001年第6期389-391,共3页Journal of Applied Clinical Pediatrics

基　　金：卫生部科学基金国家 95攻关专题 (项目编号 :98- 1 - 2 61 )

摘　　要：目的　了解雾化吸入硝酸甘油 (NebulizednitroglycerinNeb NTG)对先天性心脏病并肺动脉高压患儿血流动力学的影响 ,探讨治疗肺动脉高压的的新途径。方法　采用空气压缩泵作为雾化发生器吸入NTG[2 0μg/ (kg·次 ) ],动态监测患儿血压、心率 ,于吸入Neb NTG前、吸入后 10min、吸入后 30～ 6 0min及吸入Neb NTG治疗 3d后超声心动图测量左室射血分数 (EF)和短轴缩短率 (FS)、右室射血前期 (RPER)、加速时间(AT)、肺动脉平均压 (PAMP)、肺动脉收缩压 (PASP)和肺动脉峰值血流速度 (PA)的变化。结果　Neb NTG对血压、心率、EF、FS和PA无影响 (P >0 .0 5 ) ;吸入Neb NTG后 10min、30～ 6 0minRPER/AT、PAMP和PASP有下降趋势 ,但与吸入前比较 ,差别无显著性意义 (P >0 .0 5 ) ;吸入Neb NTG 3d后RPEP/AT、PAMP和PASP明显下降 ,分别由 0 .97± 0 .33mmHg降至 0 .81± 0 .31mmHg、39± 13mmHg降至 30± 12mmHg、5 4± 17mmHg至 43± 13mmHg ,与吸入前比较 ,差别有显著性意义 (P >0 .0 5 )。结论　吸入Neb NTG可能是一种有效的、简单的、选择性的、优于静脉NTG的肺血管扩张剂 。Objective To observe the effect of nebulized inhalation of nitroglycerin (Neb NTG)on hemodynamics in children with pulmonary hypertension secondary to congenital heart disease.Methods The air compressor pump was used as nebulizer to inhale Neb NTG (20 μg/kg). Heart rate and blood pressure were monitored continuously. Echocardiography was used to measure the ejection fraction (EF),fraction shortening(FS), the right pre ejection time(RPEP) and the ratio of RPEP to AT. Pulmonary artery systolic pressure(PASP) and pulmonary artery mean pressure(PAMP) were calculated .Results There was no significant difference in heart rate, blood pressure, ejection fractional shortening of left ventricle before and after the use of Neb NTG(P>0.05). After 10 minutes and 30～60 minutes of inhalation of Neb NTG, there was a tendency of a decrease in PRPE/AT, PAMP and PASP. But compared with those before the inhalation of Neb NTG, there was no statistical difference observed(P>0.05). Inhalation of Neb NTG was used to treat pulmonary hypertension for 3 days, and pulmonary artery pressure was obviously decreased. RPEP/AT, PAMP and PASP decreased from 0.97±0.33,39±13 mmHg and 54±17 mmHg to 0.81±0.31 mmHg, 30±12 mmHg and 43±13 mmHg, respectively , compared with those before the inhalation of Neb NTG,P0.05.Conclusion The nebulized nitroglycerin may be an effective and easy selective pulmonary vasodilator for the treatment of pulmonary hypertension.

关 键 词：肺动脉高压 硝酸甘油 雾化吸入 先天性心脏病 并发症 治疗 血流动力学 儿童 

分 类 号：R725.4[医药卫生—儿科]