The Clinical Applications Of Inhaled Nitric Oxide In Congenital Heart Disease With The Pulmonary Hypertension After Operation

Objective: The purpose of this study was to discuss the efficacy of inhaled NO in cardiac surgical patients with pulmonary hypertension after cardiac operation in order to explore the dose-response-time relationship and the possible mechanism so as to provide theoretical basis for treating and preventing severe followed syndrome of pulmonary hypertension.Method: Ten patients of congenital heart disease with the pulmonary hypertension after operation (mPAP>30mmHg) were studied. Hemodynamic index was determined at five points of data collection: before nitric oxide, with 5 minutes, 10 minutes, 30 minutes, 1hour after nitric oxide. Statistical analysis was by analysis of independent simple T test; significance was accepted for p <0.05.Results: The PAP of all the patients measured through main pulmonary artery was much higher than normal. With inhalation of 15-20ppm nitric oxide, the patient's hemodynamics of pulmonary circulation was improved. Pulmonary artery pressure decreased significantly while body circulation was stabile: With INO 5 minutes, 10 minutes,30 minutes, 1hour there was no much change about the HR of patient compared with the baseline before INO(P>0.05). With INO 5 minutes, 10 minutes,30 minutes, lhour there was also no much change about the mean artery pressure of patient compared with the baseline before INO (P>0.05). But With INO 5 minutes, 10 minutes, 30 minutes, 1hour there was a significant decrease in mean pulmonary artery pressure and Pulmonary vascular resistance compared with the baseline before INO(P <0.01). This indicated that NO could selectively extend pulmonary artery ,as so induced PAP and PVR while had little effect on body circulation.Conclusion: The inhalation of 15-20ppm NO can improve the hemodynamics of pulmonary circulation of patient with pulmonary hypertension after open-heart operation, significantly induce PAP and PVR while has little effect on the bodycirculation. It was seriously important to the therapy of congenital heart disease with the fixed pulmonary hypertension after operation and pulmonary hypentensive crisis.