一氧化氮和米力农联合应用防治心脏病术后右心衰竭

目的联合应用一氧化氮（NO）与米力农（Mil）防治心脏病术后右心衰竭,降低iNO撤离后反跳率,并初步探讨其机制。方法选择体外循环下行心脏畸形矫治的先天性心脏病合并肺动脉高压患儿32例,随机分为iNO组（iNO10ppm吸入）16例和iNO＋Mil组iNO10ppm吸入后1h启用米力农0.5μg/（kg.min）静脉维持]16例。比较两组治疗后血流动力学、血气分析、NO吸入时间、呼吸机辅助时间、住ICU时间、术后住院时间及NO撤离的反跳发生率等。结果 iNO＋Mil组中心静脉压（CVP）、跨肺压（TPG）降幅显著高于iNO组（P〈0.05）,动脉收缩压（SAP）、动脉氧饱和度（SaO2）升幅显著高于iNO组（P〈0.05）。NO撤离后反跳率明显降低,并缩短了NO吸入时间、呼吸机辅助时间、住ICU时间、术后住院时间。结论 NO与Mil联合应用可有效防治心脏病术后右心衰竭。

Treating postoperative right ventricular failure by using nitric oxide and milrinone

Objective To study the effect of inhaled nitric oxide（iNO）associated with milrinone（Mil）on postoperative right ventricular failure（RVF）,and reduce the occurrence of iNO withdrawal rebound.Methods 32 patients with congenital heart diseases and pulmonary hypertension undergoing cardiopulmonary bypass（CPB）were randomly divided into two groups：group iNO（iNO at 10ppm,n=16）and group iNO＋Mil（iNO at 10ppm and Mil at 0.5μg/（kg·min） one hour after NO inhalation,n=16）.Hemodynamics、arterial blood oxygenation、iNO time、intubation time、the time of stay in intensive care unit and hospital after operation,and occurrence of iNO withdrawal rebound were compared between the two groups.Results Compared with The iNO group,decrement of central venous pressure（CVP）、transpulmonary pressure gradient（TPG）and increment of systemic arterial pressure（SAP）、arterial oxygen saturation（SaO2）were significantly higher in group iNO＋Mil（P0.05）,occurrence of iNO withdrawal rebound were significantly lower in group iNO＋Mil.The iNO time、the intubation time、the time of stay in intensive care unit and hospital after operation were less or shorter in group iNO＋Mil（P0.05）.Conclusion Postoperative RVF can be treated efficiently by using iNO＋Mil.