一氧化氮与波生坦治疗主动脉弓离断合并室间隔缺损伴重度肺动脉高压疗效的随机对照试验  

Curative effect of nitric oxide and bosentan on treatment of the interruption of aortic arch with ventricular septal defect and serious pulmonary hypertension: A randomized controlled study

作　　者：宋海龙[1] 陶曙光[1] 杨仕海[1] 温林林[1] 金立臣[1] 王建明[1] SONG Hailong;TAO Shuguang;YANG Shihai;WEN Linlin;JIN Lichen;WANG Jianming(Department of Cardiac Surgery,Children＇s Hospital of Hebei Province,Shijiazhuang,050031,P.R.China)

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》2018年第10期839-843,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比分析一氧化氮(NO)与波生坦在治疗主动脉弓离断合并室间隔缺损伴重度肺动脉高压的疗效差异。方法选择2015年1月至2017年5月河北省儿童医院心脏外科经心脏超声和心脏及大血管CT确诊为主动脉弓离断合并室间隔缺损伴重度肺动脉高压的患儿32例,其中男17例、女15例,年龄1.10~4.30(2.71±0.98)个月,体质量3.33~6.10(4.57±0.88)kg。将患儿随机分为NO组与波生坦组,每组各16例。所有患儿均行主动脉弓离断矫治术+室间隔缺损修补术。NO组患儿于术后半小时开始吸入NO,吸入浓度20 ppm,吸入时间为36 h,波生坦组患儿于术后半小时鼻饲波生坦(0.015 g,2次/d),分别测算两组患儿术后3 h、6 h、12 h、24 h、36 h心指数、肺/体循环压力比值及氧合指数,并比较上述指标的差异。结果术后两组患儿肺循环/体循环压力比值均先升后降,氧合指数均先降后升,同组患儿相邻被测时间点差异均具有统计学意义(P均<0.05);两组患儿术后心指数均先降后升,除波生坦组术后6 h与12 h差异无统计学意义(P>0.05)外,同组患儿相邻被测时间点差异均具有统计学意义(P均<0.05);术后6 h、12 h NO组患儿氧合指数明显大于波生坦组,NO组肺循环/体循环压力比值明显小于波生坦组(P均<0.01),术后6 h、12 h、24 h NO组心指数大于波生坦组,差异具有统计学意义(P均<0.05),其中术后12 h NO组心指数明显大于波生坦组(P<0.01),其它同时间点两组相应指标差异均无统计学意义(P均>0.05)。结论吸入NO在治疗主动脉弓离断合并室间隔缺损伴重度肺动脉高压患儿术后早期肺动脉高压效果优于波生坦,但在术后中后期二者效果相近。Objective To analyze the curative effect of nitric oxide （NO） and bosentan on treatment of the interruption of aortic arch （IAA） with ventricular septal defect （VSD） and serious pulmonary hypertension （SPH）. Methods Thirty-two children with IAA and VSD combined SPH from January 2015 to May 2017 confirmed by cardiac CT and ultrasound in Children＇s Hospital of Hebei Province were enrolled including 17 males and 15 females, aged 1.10-4.30 months （mean, 2.71±0.98 months） and weighing 3.33-6.10 kg （mean, 4.57±0.88 kg）. The 32 children were randomly divided into two groups （n=16 in each）, a NO group and a bosentan group. All the patients underwent interruption of aortic arch and ventricular septal defect repair. When patients returned to cardiosurgery intensive care unit （CSICU） half an hour later, patients in the NO group inhaled NO 20 ppm for 36 h and those in the bosentan group were given bosentan by nasogastric feeding 15 mg, twice a day. The cardic index, pulmonary/systemic pressure ratio, oxygenation index at 3 h, 6 h, 12 h, 24 h, 36 h after surgery were evaluated, and the differences between the two groups were compared. Results The pulmonary/systemic pressure ratio in the two groups increased at first and then decreased,while oxygenation index in the two groups decreased at first and then increased, and the differences in the same groups at the adjacent time points were statistically significant （P〈0.05）. The cardiac index in the two groups decreased at first and then increased, the differences in the same groups at the adjacent time points were statistically significant, except for 6 h and 12 h after surgery in the bosentan group （P〉0.05）. At postoperative 6 h, 12 h, the oxygenation index in the NO group was significantly higher than that in the bosentan group, and the pulmonary/systemic pressure ratio in the NO group was less than that in the bosentan group （P〈0.01）. The cardiac index in the NO group was higher than that of the bosentan group after 6 h, 12

关 键 词：主动脉弓离断 重度肺动脉高压 一氧化氮 波生坦 

分 类 号：R726.5[医药卫生—儿科]