Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study
Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study
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吸入一氧化氮对急性 A 型主动脉夹层术后低氧血症的影响：一项回顾性观察研究
DOI：
10.1186/s13019-020-1069-6
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发表时间：
2020-01-22
影响因子：
1.6
通讯作者：
Yu, Min
中科院分区：
文献类型：
--
作者：
Zhang, Hang;Liu, Yaoyang;Yu, Min
急性A型主动脉夹层（AADA）术后低氧血症是一种常见的并发症，与不良结局相关。本研究旨在分析低剂量（5-10 ppm）吸入一氧化氮（iNO）治疗AADA手术后低氧血症的疗效。方法在这项回顾性观察性研究中，收集了2015年1月至2018年1月在两家机构接受AADA手术的患者的病历。术后低氧血症患者分为iNO组和对照组。使用倾向评分匹配（PSM）分析比较临床特征和结局。结果436例患者中187例（42.9%）出现低氧血症，43例患者接受小剂量iNO治疗。PSM后，患者以1：3的比例被纳入iNO治疗组（n = 40）和PSM对照组（n = 94）。iNO可改善低氧血症，并缩短呼吸机支持时间（39.0 h（31.3-47.8）vs. 69.0 h（47.8-110.3），p < 0.001）和ICU停留时间（122.0 h（80.8-155.0）vs. 179.5 h（114.0-258.0），p < 0.001）。在死亡率、并发症或住院时间方面，组间无显著差异。结论在本研究中，我们发现低剂量iNO可改善AADA术后低氧血症患者的氧合，缩短机械通气和ICU停留时间。iNO治疗未观察到显著的副作用或术后死亡率或发病率的增加。这些发现证明了一项随机多中心对照试验，以评估iNO对AADA后低氧血症的确切疗效。
Background Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5-10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery. Methods In this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis. Results Among 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3-47.8) vs. 69.0 h (47.8-110.3), p < 0.001) and ICU stay (122.0 h (80.8-155.0) vs 179.5 h (114.0-258.0), p < 0.001). There were no significant between-group differences in mortality, complications, or length of hospital stay. Conclusions In this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.