摘要
目的探讨吸入一氧化氮(NO)对肺血减少型紫绀型先天性心脏病(CHD)根治术后患儿血流动力学的效应。方法 2014~2018年,阜外医院小儿外科中心实施肺血减少型紫绀型CHD根治手术1 764例,纳入停机后测定右心室收缩压与主动脉收缩压之比≥75%的患儿共61例,其中男41例、女20例,年龄20.5(9.0,39.0)个月,体重(12.5±7.8)kg。将患者分为常规治疗组(33例)和联合治疗组(常规治疗联合NO吸入治疗,28例)。观察NO吸入后24 h内的血流动力学参数变化,并对比两组患儿主要临床指标的变化。结果两组患儿的人口学特征及手术相关指标差异均无统计学意义(P>0.05)。联合治疗组患儿在吸入NO后24 h内总体的血流动力学效应表现为:血管活性药物评分(VIS)降低(21.6±6.6 vs. 17.3±7.2,P=0.020)的同时血压升高[收缩压(73.7±9.7)mm Hg vs.(90.8±9.1)mm Hg,P<0.001],中心静脉压降低[(10.0±3.1)mm Hg vs.(7.9±2.1)mm Hg,P=0.020],尿量增加[(2.8±1.7)mL/(kg·h)vs.(4.9±2.2)mL/(kg·h),P<0.001],血乳酸降低[(2.2±1.7)mmol/L vs.(1.2±0.5)mmol/L,P<0.001]。常规治疗组术后24 h VIS差异无统计学意义(22.1±7.9 vs. 20.0±8.5,P=0.232)。联合治疗组患儿对肾脏替代治疗的需求少于常规治疗组,特别是在术式中等复杂[心脏手术的危险等级评分(RACHS-1)≤3级]的病例中更明显(9.5%vs. 40.7%,P=0.016)。结论对合并肺血管阻力增高的肺血减少型紫绀型CHD根治手术后的围术期治疗,联合NO吸入治疗可有效改善血流动力学状态。相比于常规治疗,联合NO吸入降低VIS的效果更明显,并可减少对肾脏替代治疗的需求,有利于患儿的术后恢复。
Objective To explore the hemodynamic effects of inhaled nitric oxide(iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease(CHD) combined with decreased pulmonary blood flow.Methods From 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure(SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5(9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group(33 patients, conventional therapy only) and a combined therapy group(28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared. Results There was no statistical difference between the two groups in demographic characteristics and surgical parameters(P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score(VIS, 21.6±6.6 vs.17.3±7.2, P=0.020) along with the increase in blood pressure(SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001), the decrease in central venous pressure(10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate(2.2±1.7 mmol/L vs. 1.2±0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant(22.1±7.9 vs. 20.0±8.5,P=0.232). Besides, we discovered that the need for renal replacement therapy(RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery(RACHS-1) ≤3] subgroup(9.5% vs. 40.7%, P=0.016).
作者
王晓峰
鲁中原
沈瑞环
王旭
WANG Xiaofeng;LU Zhongyuan;SHEN Ruihuan;WANG Xu(Department of Pediatric Intensive Care Unit,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2021年第12期1461-1465,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家重点研发计划(2017YFC1308100)
中国医学科学院临床与转化医学基金项目(2019-F26-LC)。
关键词
吸入一氧化氮
紫绀型先天性心脏病
肺高压
血流动力学
肾脏替代治疗
Inhaled nitric oxide
cyanotic congenital heart disease
pulmonary hypertension
hemodynamic
renal replacement therapy
