低剂量吸入性一氧化氮治疗孙氏手术术后严重低氧血症疗效的回顾性队列研究  

Efficacy of low-dose inhaled nitric oxide in the treatment of severe hypoxemia after Sun’s operation:A retrospective cohort study

作　　者：马晓中 张韶鹏 白云鹏 吴振华[2] 赵丰[1] 陈庆良[1] 姜楠[1] MA Xiaozhong;ZHANG Shaopeng;BAI Yunpeng;WU Zhenhua;ZHAO Feng;CHEN Qingliang;JIANG Nan(Department of Cardiac Surgery,Tianjin Chest Hospital,Tianjin,300222,P.R.China;Intensive Care Unit,Tianjin Chest Hospital,Tianjin,300222,P.R.China)

机构地区：[1]天津市胸科医院心外科,天津300222 [2]天津市胸科医院重症监护室,天津300222

出　　处：《中国胸心血管外科临床杂志》2024年第5期762-767,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：天津市医学重点学科(专科)建设项目;天津市心血管急危重症重点实验室;天津市主动脉夹层信息化平台的建立(21JCZDJC00610);天津市科技计划项目(22JCYBJC01430)。

摘　　要：目的研究应用低剂量吸入性一氧化氮(inhaled nitric oxide,iNO)治疗孙氏手术术后严重低氧血症的疗效。方法回顾性分析2020年1月—2022年6月于天津市胸科医院行孙氏手术急性A型主动脉夹层患者的临床资料。2021年11月之前患者进行常规治疗,作为对照组;2021年11月之后我院开始使用低剂量iNO治疗,作为iNO组。比较两组患者术前临床基线资料、围术期临床数据及氧合指数变化等。结果对照组共纳入54例患者,其中男45例、女9例,平均年龄(53.0±10.9)岁;iNO组共纳入27例患者,其中男21例、女6例,平均年龄(52.0±10.6)岁。两组患者术前体重指数均>25 kg/m^(2),白细胞计数、C反应蛋白均明显高于正常值,但组间差异无统计学意义(P>0.05)。两组术中资料差异均无统计学意义(P>0.05)。iNO组机械通气时间、术后ICU停留时间和术后住院时间均显著短于对照组(P<0.001)。在12 h的iNO治疗后,iNO组的低氧状态改善明显,iNO组的氧合指数在12 h、24 h、36 h、48 h、60 h及72 h均显著高于对照组(P<0.05)。结论低剂量iNO治疗孙氏手术术后严重低氧血症安全、有效,可显著提升氧合功能,在缩短呼吸机使用时间、术后ICU停留时间和术后住院时间方面有优势,但在改变术后病死率等临床治疗结果方面并不显著。Objective To investigate the efficacy of low-dose inhaled nitric oxide(iNO)in the treatment of severe hypoxemia after Sun’s operation.Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed.Patients who received conventional treatment before November 2021 were enrolled as a control group.After November 2021,iNO was used in our hospital,and the patients who received iNO as an iNO group.The preoperative clinical baseline data,perioperative clinical data and oxygenation index were compared between the two groups.Results A total of 54 patients were included in the control group,including 45 males and 9 females,with an average age of 53.0±10.9 years.A total of 27 patients were included in the iNO group,including 21 males and 6 females,with an average age of 52.0±10.6 years.The preoperative body mass index of the two groups was greater than 25 kg/m^(2),white blood cell count,C-reactive protein were significantly higher than normal level,but there was no statistical difference between the groups(P>0.05).There were no statistical differences in intraoperative data between the two groups(P>0.05).The iNO group had significantly shorter duration of mechanical ventilation,postoperative ICU stay,and postoperative hospital stay than the control group(P<0.001).After 12 h of iNO treatment,hypoxic condition improved obviously,oxygenation indices in 12 h,24 h,36 h,48 h,60 h and 72 h in the iNO group were significantly higher than those in the control group(P<0.05).Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective,can significantly improve oxygenation function,and has significant advantages in shortening ventilator use time,postoperative ICU stay and postoperative hospital stay,but it is not significant in changing postoperative mortality.

关 键 词：吸入性一氧化氮 低剂量 孙氏手术 低氧血症 

分 类 号：R654.3[医药卫生—外科学]