吸入一氧化氮治疗急性A型主动脉夹层术后严重低氧血症的疗效研究  

The effect of inhaled nitric oxide therapy on severe hypoxemia following type A acute aortic dissection surgery

作　　者：鲍春荣[1] 朱家全[1] 张俊文[1] 马南[1] 杨琦[1] 江雪燕 袁源[1] 丁芳宝[1] 梅举[1] BAO Chun-rong;ZHU Jia-quan;ZHANG Jun-wen;MA Nan;YANG Qi;JIANG Xue-yan;YUAN Yuan;DING fang-bao;MEI Ju(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2021年第5期399-403,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的研究应用吸入一氧化氮(iNO)治疗急性A型主动脉夹层(acute type A aortic dissection,ATAAD)手术后严重低氧血症的疗效。方法回顾性分析2015年1月至2020年12月我院手术的ATAAD患者资料,排除术后72h内病死、术后卒中和截瘫患者,共48例严重低氧血症(氧合指数<100 mm Hg)患者入组。2018年9月之前采用常规疗法,共28例,归入CON组;2018年10月之后应用吸入一氧化氮治疗共20例,归入iNO组,该组除了常规方法外给予吸入体积分数为5×10^(-6)的一氧化氮。结果两组术前资料、术中手术方式、时间和输血量等均无统计学差异。术后CON组低氧血症改善缓慢,iNO组氧合指数上升明显加快。术后早期病死率iNO组(10%)与CON组(10.7%)相比差异无统计意义。iNO组机械通气时间(87.3±13.1)h低于CON组(128.5±16.6)h,ICU停留时间iNO组(12.1±1.57)d低于CON组(14.4±1.93)d,术后住院时间iNO组(19.8±1.64)d短于CON组(21.4±1.93)d。结论i NO治疗ATAAD术后严重低氧血症安全有效,可显著促进患者氧合功能改善和缩短气管插管呼吸机使用时间。Objective To evaluate the effect of inhaled nitric oxide(iNO)therapy on patients suffered from severe hypoxemia following acute type A aortic dissection(ATAAD)surgery.Methods The clinical data of patients who underwent surgery for ATAAD in our institution from Jan.2015 to Dec.2020 were analyzed.Those who died within 72 hours after surgery and complicated with postoperative stroke and paraplegia were excluded.Forty-eight cases with severe hypoxemia(oxygenation index PaO_(2)/FiO_(2)<100 mmHg)were included.Twenty-eight patients treated with conventional therapy before Sep.2018 were divided into CON group.Twenty patients treated with volume fraction of 5×10^(-6) iNO except for conventional therapy were divided into iNO group.Results There was no difference in the preoperative data,the surgical strategy,surgery time and blood transfusion volume during the surgery between two groups.In CON group,alleviation of hypoxemia was very slow.While in iNO group,oxygenation index went up more rapidly.There was no difference of mortality between two groups(10.7%vs10%).The mechanical ventilation time of iNO group(87.3±13.1)h was significantly less than CON group(128.5±16.6)h.The intensive care unit(ICU)stay time of iNo group(12.1±1.57)d was shorter than CON group(14.4±1.93)d.The hospital stay time of iNO group(19.8±1.64)d was less than CON group(21.4±1.93)d.Conclusion Inhaled iNO was effective and safe for treating severe hypoxemia after surgery for ATAAD.This therapy may improve oxygenation function rapidly and shorten mechanical ventilation time,ICU stay time and hospital stay time.

关 键 词：吸入一氧化氮 急性A型主动脉夹层 心脏外科手术 低氧血症 

分 类 号：R654.2[医药卫生—外科学]