术后早期吸入一氧化氮联合波生坦治疗大动脉异位伴巨大室间隔缺损合并重度肺动脉高压的临床研究  

Clinical analysis of early postoperative application of nitric oxide combining with bosentan for reeatment of malposition of the great arteries with large ventricular septal defect and severe pulmonary hypertension in children

作　　者：宋海龙[1] 陶曙光[1] 杨仕海[1] 温林林[1] 金立臣[1] 韩剑刚[1] 谷疆蓉[1] 王建明[1] SONG Hailong, TAO Shuguang, YANG Shihai, WEN Linlin, JIN Lichen, HAN Jiangang , GU Jiangrong , WANG Jianming(Department of Cardiac Surgery, Children＇ s Hospital of Hebei Province, Shijiazhuang 050031, Chin)

机构地区：[1]河北省儿童医院心脏外科,050031

出　　处：《心肺血管病杂志》2018年第3期210-213,217,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨术后早期应用一氧化氮(NO)联合波生坦治疗大动脉异位伴巨大室间隔缺损合并重度肺动脉高压疗效。方法:2015年1月至2017年5月,就诊于河北省儿童医院心外科,经心脏超声和/或心脏大血管CT确诊,大动脉异位伴巨大室间隔缺损合并重度肺动脉高压34例患儿,其中完全型大动脉转位伴巨大室间隔缺损合并重度肺动脉高压18例,Taussig-Bing畸形伴巨大室间隔缺损合并重度肺动脉高压16例。男性19例,女性15例,年龄3~5个月,平均(4.53±0.18)个月,体质量3.8~5.7kg,平均(5.27±0.16)kg,将34例患儿随机分为A组和B组,每组各17例。所有患儿均行大动脉调转术加室间隔缺损修补术。A组患儿于术后返回监护室30min后给予吸入NO,吸入浓度为20ppm,吸入时间为36 h,监测二氧化氮和高铁血红蛋白浓度,同时给予鼻饲波生坦(15.625mg、2次/日)。B组患儿于术后返回监护室30min后给与鼻饲波生坦(剂量及用法同A组),分别测算两组患儿术后3h、8h、24h、36h、48h肺循环/体循环压力比值、氧合指数及心指数,并进行比较。结果:两组患儿中A组肺循环/体循环压力比值下降幅度、氧合指数及心指数上升幅度均大于B组。A组术后各时段肺循环/体循环压力比值均小于B组,同时间点相比,两组间差异具有统计学意义(P<0.05);其中术后8h、24h、36h A组肺循环/体循环压力比值明显小于B组,两组间差异具有统计学意义(P均<0.01)。术后3h A、B两组氧和指数差异无统计学意义;术后8h、24h、36h、48h A组氧和指数均明显大于B组,差异均具有统计学意义(P均<0.01)。术后3h、8h A、B两组心指数,差异无统计学意义(P均>0.05);术后24h、36h、48h A组心指数大于B组,同时间点相比两组间差异具有统计学意义(P均<0.05);其中术后36h、48h A组心指数明显大于B组,两组之间差异具有统计学意义(P均<0.01)。结论:NO联合波生坦治疗大动脉异位伴巨大室间隔缺损�Objective： To discuss the curative effect of early postoperative application of nitric oxide（ NO） combining with bosentan for treatment uniting nitric oxide（ NO） and bosentan with simple application of bosentan in treatment of malposition of the great arteries with large ventricular septal defect and severe pulmonary hypertension in children. Methods： 34 children in MGA with large vsd and severe PH from January 2015 to May 2017 were certified by cardiac CT and/or ultrasound,,in children＇ s hospital of He Bei Province. Therewere 18 children in transposition of the great arteries（ TGA） with large vsd and severe PH and 16 children were in Taussig-Bing with large vsd and severe PH. And 19 children were male,15 were female,whose age ranged from 3 moths to5 months,（ average age： 4. 53 ± 0. 18 months） and weight ranged from 3. 8-5. 7 kg（ average weight： 5. 27 ± 0. 16 kg）. The 34 children were randomly divided into two groups,（ n = 17 in each） ： group A and group B. All of the 34 children were performed by arterial switch repair and vsd repair. When the children in group A returned to Cardiosurgery Intensive Care Unit（ CSICU） 30 minutes later,they inhaled NO 20 ppm for 36 hours,meanwhile concentrations of nitrogen dioxide and methemoglobin were detected,and at the same time bosentan was given by nasogastric feeding,15. 625 mg,twice a day. Children in group B were given bosentan by nasogastric feeding 31. 25 mg,twice a day,30 minutes later when they teturned to CSICU. The liver functions of two groups were tested regularly,and the ratio of pulmonary circulation/general circulation、oxygenation index and cardiac index were measured and compared at the time of 3 hours,8 hours,24 hours,36 hours,48 hours after operations. Results： ratio of pulmonary circulation/general circulation in group A fell further than in group B,oxygenation index in group A rised more than in group B. Ratio of pulmonary circulation/general circulation in group A were significantly smaller than in group B at

关 键 词：一氧化氮 波生坦 大动脉异位伴肺动脉高压 

分 类 号：R54[医药卫生—心血管疾病]