Inhaled nitric oxide as a salvage therapy for refractory hypoxemia in the post-transplantation period of hepatopulmonary syndrome:An explorative report of three cases  

作　　者：Haijin Lyu Xiaomeng Yi Yunshan Zou Pinglan Lu Lijuan Li Jianrong Liu Senbiao Chen Xuxia Wei Yang Yang Huimin Yi 

机构地区：[1]Surgical Intensive Care Unit,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong,China [2]Guangdong Provincial Key Laboratory of Liver Disease Research,Guangzhou,Guangdong,China [3]Department of Hepatic Surgery and Liver Transplantation Center,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong,China

出　　处：《Liver Research》2024年第3期188-192,共5页肝脏研究（英文）

基　　金：National Natural Science Foundation of China(No.82270690 and 82200732);Natural Science Foundation of Guangdong Province(No.2021A1515012382,2022A1515011919 and 2022A1515012519).

摘　　要：Liver transplantation(LT)is the only effective treatment for hepatopulmonary syndrome(HPS).Moreover,perioperative refractory hypoxemia(pRH)is a prevalent life-threatening condition and has extremely limited treatment options.Here,we report three patients with HPS who experienced pRH after LT and were consecutively treated with different salvage therapies,ephedrine inhalation,intravenous use of methylene blue with nitric oxide(NO)inhalation,and NO inhalation alone.The results showed that unresolved severe hypoxia may induce fatal morbidity such as early biliary leakage and acute kidney injury.Early initiation of NO inhalation,rather than ephedrine,can significantly improve oxygenation in patients with pRH and may help prevent hypoxia-related complications.Therefore,based on the response to these exploratory salvage treatments,we further demonstrate the unique ventilation-perfusion mismatch pathophysiology in specific lung regions during pRH in HPS.We propose that early inhalation of NO is an important treatment option to rescue severe hypoxia in patients with HPS during the perioperative period of LT.

关 键 词：Hepatopulmonary syndrome Liver transplantation Hypoxia Nitric oxide(NO) VASODILATORS Ventilation-perfusion mismatch 

分 类 号：R575[医药卫生—消化系统]