围术期吸入一氧化氮对室间隔缺损合并重度肺高压婴幼儿术后心肺功能影响的随机对照试验  

Effect of inhaling NO perioperatively on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension: A randomized controlled trial

作　　者：宋海龙[1] 温林林[1] 杨仕海[1] 陶曙光[1] 韩剑刚[1] 金立臣[1] 王建明[1] 曹利静[1] 

机构地区：[1]河北省儿童医院心脏外科,石家庄050031

出　　处：《中国胸心血管外科临床杂志》2017年第7期501-505,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨围术期短时低流量吸入NO对先天性室间隔缺损合并重度肺动脉高压患儿术后心肺功能的影响。方法选取2014年5月至2016年5月我院45例先天性室间隔缺损合并重度肺动脉高压的患儿,其中男19例、女26例,年龄1~22(7.2±14.4)个月、体质量2.7~10.5(6.8±3.6)kg。根据围术期是否吸入NO,将他们随机分为空白组、先吸组、后吸组3组,每组各15例。其中空白组患儿不吸入NO,先吸组患儿于麻醉、气管插管后开始吸入NO 10 min,后吸组患儿于主动脉开放后开始吸入NO 10 min,吸入浓度均为20×10^(–6),测算3组患儿返回监护室(ICU)后10 min,术后1 h、3 h、24 h肺循环/体循环压力比值、心指数、氧合指数,监测肌钙蛋白数值,比较上述指标的差异。结果术后3 h内,后吸组肌钙蛋白数值升高幅度最大,空白组次之,先吸组最小。术后1 h和3 h先吸组肌钙蛋白数值明显小于空白组及后吸组,差异均有统计学意义(P<0.01);每组术后24 h的数值均低于术后3 h。术后先吸组心指数均高于同时段的空白组及后吸组;返回ICU后10 min、术后3 h和24 h先吸组与后吸组之间差异均具有统计学意义(P<0.05)。术后3 h内,后吸组肺循环/体循环压力比值升高幅度最大,空白组次之,两组术后3 h与返回ICU 10 min相比,差异均有统计学意义(P<0.01);3组术后24 h肺循环/体循环压力比值与返回ICU后10 min差异均无统计学意义(P>0.05)。先吸组氧合指数高于同时段空白组和后吸组,与后吸组差异有统计学意义(P<0.05)。结论术前预吸NO 10 min可有效减轻手术对于心肺功能的损伤,但主动脉开放后吸入NO 10 min作用相反。Objective To investigate the effect of low-flow inhaling NO for short time on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension. Methods Forty-five patients with congenital ventricular septal defect complicated with severe pulmonary hypertension from May 2014 to May 2016 in our hospital were enrolled. There were 19 males and 26 females, whose age ranged from 1 to 22 months （average age： 7.2±14.4 months） and weight ranged from 2.7 to 10.5 kg （average weight： 6.8±3.6 kg）. The patients were randomly divided into three groups （n=15 in each）： the blank group, the prior inhalation group and the posterior inhalation group. The blank group did not inhale NO, and the prior inhalation group inhalated NO for 10 min after tracheal and intubation. After the opening of the aorta, the posterior inhalation group inhaled NO for 10 min. The concentration of NO was 20 × 10-6. The pressure ratio of pulmonary circulation/systematic circulation, heart index and oxygenation index were calculated and the troponin value of the three groups was monitored 10 min after returning to intensive care unit （ICU） and postoperatively 1 h, 3 h and 24 h. Differences among above indicators between three groups were compared. Results The troponin value of the posterior inhalation group within 3 h increased most, followed by the blank group and the prior inhalation group. Postoperatively 1 h and 3 h, the troponin value of the prior inhalation group was significantly less than that of the blank group and posterior inhalation group （P〈0.01） and the value on postoperative 24 h in each group was lower than that on postoperative 3 h. The cardiac index of prior inhalation group was higher than that of the blank group and the posterior inhalation group at each time point. Postoperatively 3 h and 24 h as well as 10 min after returning to ICU, the cardiac index in prior inhalation group was significantly higher than that of the posteri

关 键 词：先天性室间隔缺损 肺动脉高压 一氧化氮 心指数 氧合指数 肌钙蛋白 

分 类 号：R726.5[医药卫生—儿科]