【摘要】 目的观察压力调节容积控制通气(PRVC)联合一氧化氮(NO)吸入疗法对心脏手术后肺动脉高压患者的治疗作用。方法12例心脏手术后肺动脉高压患者随机采用间歇正压通气(SIMV)、SIMV+NO、PRVC和PRVC+NO进行治疗。于治疗前及治疗后30min观察血流动力学,气体交换及肺功能改变,并于NO吸入前后记录血浆高铁血红蛋白(MetHb)含量。结果各组治疗前参数无明显差异(P>0.05)。治疗后30min,SIMV和PRVC组对血流动力学无明显影响;PRVC组肺静态顺应性(Cst)显著增加(P<0.05)。在NO吸入后,SIMV及PRVC组平均动脉压(MAP)明显升高,平均肺动脉压(mPAP)分别由(34±4)mmHg、(38±8)mmHg降至(26±3)mmHg和(21±5)mmHg,且差异有显著性(P<0.05);同时,PRVC+NO组Cst和氧合指数(PaO2/FiO2)明显增加(P<0.05);上述指标在SIMV、SIMV+NO组则无明显变化。此外,NO吸入后MetHb虽有升高,但均在正常范围。结论与SIMV+NO相比,PRVC+NO能进一步降低心脏手术后肺动脉高压患者的mPAP,增加其Cst及PiO2/FiO2。更多还原

【Abstract】 Objective To observe the effects of low concentration nitric oxide (NO) inhalation with pressure regulate volume controlled ventilation (PRVC) on gas exchange and hemodynamics in patients with pulmonary hypertension after cardiac surgery. Methods Twelve patients with pulmonary hypertension after cardiac surgery were randomly allocated to different groups: SIMV, SIMV+NO, PRVC and PRVC+ NO. The hemodynamic gas exchange and lung function were recorded at baseline and 30 min after the treatment. The content of methemoglobin was detected before and after the NO inhalation. Results At the baseline, all the parameters in four groups showed no significant differences (P >0.05). 30 minutes after the treatment, patients in SIMV and PRVC group did not present with significantly improve in hemodynamic. Static lung compliance (Cst) increased significantly (P <0.05) in PRVC group. After NO inhalation, the MAP increased significantly in group SIMV and PRVC. The mean pulmonary pressure (mPAP) decreased significantly (P <0.05) if compare group PRVC (38±8) mmHg with group PRVC+NO (21±5)mmHg, also compare group SIMV (34±4)mmHg with group SIMV+NO (26±3) mmHg. The Cst and PaO2/FiO2 increased significantly (P <0.05) in group PRVC+NO. While there was no significant difference in Cst and PaO2/FiO2 between groups SIMV and SIMV+NO. During inhalation NO, the levels of nitrogen dioxide (NO2) and methemoglobim (MethHb) were kept normal. Conclusion Compared with other groups, the treatment with a combined NO and PRVC could further decrease mPAP, improve Cst and PiO2 /FiO2 on the patient with pulmonary hypertension.更多还原