双向腔肺动脉吻合术后肺血流灌注不足患儿吸入NO的疗效观察_临床医学论文.docVIP

双向腔肺动脉吻合术后肺血流灌注不足患儿吸入NO的疗效观察_临床医学论文 双向腔肺动脉吻合术后肺血流灌注不足患儿吸入NO的疗效观察_临床医学论文 【摘要】 目的 探讨双向腔肺动脉吻合术（BCPS）术后肺血流灌注不足患儿吸入一氧化氮(NO)的疗效。方法 采用美国Ohemda公司NO吸入治疗仪，通过呼吸机吸入NO 2.5～20.0/百万，监测血流动力学和呼吸功能指标，定期监测NO2 、高铁血红蛋白(MetHb) 含量。结果 吸入NO后，中心静脉压，跨肺压，肺泡动脉氧分压差，呼吸指数降低(0.01)；动脉血氧饱和度，动脉血氧分压与吸入氧浓度之比上升 (0.01)。NO2 和MetHb 含量分别为(0.1±0.2)百万和(1.1±0.3)%，均在安全范围内。术后3 d 复查血小板为(231±84)×109/L，未出现血小板减少。术后近期并发低氧血症20例，其中18 例改善；低心输出量综合征(低心排) 4例；2 例颜面部水肿、8例上半身水肿，均改善。术后24 h 内 再手术4 例(由全腔肺动脉吻合术改为双向腔肺动脉吻合术)。死亡2 例，病死率5 % ，死亡原因为低心排、低氧血症。结论 外源性吸入NO 用于BCPS术后肺血管阻力暂时性增高的患儿，可改善其肺血流灌注和氧合功能，减少低心排的发生，是一种安全且有效的选择性肺血管扩张剂。 【关键词】 一氧化氮；双向腔肺动脉吻合术；血流动力学 Abstract： Objective To evaluate the therapeutic effect of nitric oxide (NO) inhalation on children with insufficient pulmonary perfusion after bidirectional cavopulmonary shunt (BCPS).Methods Forty paediatric patients (24 males, l6 females) aged from 3 months to 12 years were selected into the group. Their body weight ranged from 4.8-27.0 kg. American Ohemda NO inhalation therapeutic apparatus was applied to the patients through routine application of respirator with a NO inhaled amount of 2.5-20.0 ppm. Both the hemodynamic and respiratory function indexes were monitored, and the content of NO and metahemoglobin (MetHb) were tested regularly. Results Atier NO inhalation, the indexes of central venous pressure (CVP), transpulmonary pressure, alveolararterial oxygen partial pressure [P(Aa)O2] all decreased (0.01), while the ratio of arterial oxygen saturation and arterial partial pressure of oxygen to the inhaled oxygen concentration increased (0.01). The contents of NO2 and MetHb were respectively 0.1±0.2 ppm and 1.1±0.3%, both of which were within the safe range. The result of the platelet recheck three days after BCPS were (231±84)×109/L, which did not show any decrease. After the operation, 20 patients developed hypoxemia, 18 of whom got better later. Four patients had low cardiac output syndrome (LCOS), 2 had face edema and 8 had upper body edema. They were all improved later