Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery
Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery
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DOI：
10.1016/j.amjcard.2010.11.030
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发表时间：
2011-04-01
影响因子：
2.8
通讯作者：
Grinberg, Max
中科院分区：
文献类型：
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作者：
Fernandes, Juliano L.;Sampaio, Roney O.;Grinberg, Max
在接受心脏手术的二尖瓣狭窄患者中，特别是在术后期间，肺动脉高压是导致发病率和死亡率的重要原因。本研究的目的是在一项随机对照研究中验证吸入一氧化氮(INO)可以改善二尖瓣狭窄合并重度肺动脉高压患者的血流动力学效应和短期临床结果的假设。29例患者(男4例，女25例；平均年龄462岁)随机分为两组，每组14例，分别于术后即刻给予iNO(n=14)和氧气(n=15)治疗48小时。评估血流动力学数据、血管活性药物的使用、住院时间和短期并发症。两组之间的基线特征没有差异。24小时和48小时后，接受iNO治疗的患者的心脏指数比接受氧气治疗的患者显著增加(p<；0.0001)。在48小时内，接受iNO和氧气治疗的患者的肺血管阻力也显著降低(-117dyne/S/cm(5)，95%可信区间34至200vs40dyne/S/cm5，95%可信区间34至100，p=0.005)。INO组患者使用的全身血管活性药物较少(平均2.1+/-0.14vs2.6+/-0.16，p=0.046)，且重症监护病房住院时间较短(中位数2天，四分位数范围0.2 5，中位数3天，四分位数范围7，p=0.0 2)。综上所述，对于二尖瓣狭窄合并重度肺动脉高压的患者，术后立即应用iNO可改善血流动力学，可能具有短期临床益处。(C)2011 Elsevier Inc.保留所有权利。(美国心脏杂志2011；107：1040-1045)
Pulmonary hypertension represents an important cause of morbidity and mortality in patients with mitral stenosis who undergo cardiac surgery, especially in the postoperative period. The aim of this study was to test the hypothesis that inhaled nitric oxide (iNO) would improve the hemodynamic effects and short-term clinical outcomes of patients with mitral stenosis and severe pulmonary hypertension who undergo cardiac surgery in a randomized, controlled study. Twenty-nine patients (4 men, 25 women; mean age 46 2 years) were randomly allocated to receive iNO (n = 14) or oxygen (n = 15) for 48 hours immediately after surgery. Hemodynamic data, the use of vasoactive drugs, duration of stay, and short-term complications were assessed. No differences in baseline characteristics were observed between the groups. After 24 and 48 hours, patients receiving iNO had a significantly greater increase in cardiac index compared to patients receiving oxygen (p < 0.0001). Pulmonary vascular resistance was also more significantly reduced in patients receiving iNO versus oxygen (-117 dyne/s/cm(5), 95% confidence interval 34 to 200, vs 40 dyne/s/cm5, 95% confidence interval 34 to 100, p = 0.005) at 48 hours. Patients in the iNO group used fewer systemic vasoactive drugs.(mean 2.1 +/- 0.14 vs 2.6 +/- 0.16, p = 0.046) and had a shorter intensive care unit stay (median 2 days, interquartile range 0.25, vs median 3 days, interquartile range 7, p = 0.02). In conclusion, iNO immediately after surgery in patients with mitral stenosis and severe pulmonary hypertension improves hemodynamics and may have short-term clinical benefits. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:1040-1045)