Objectives

Pulmonary hypertension during cardiac surgery is associated with increased morbidity and mortality. Inhaled nitric oxide serves as a selective pulmonary vasodilator and has other potential extrapulmonary protective roles. Its effects on pulmonary hypertension and organ functions after adult valve surgeries were evaluated.

Methods

From April 2017 to March 2000, 30 patients received inhaled nitric oxide therapy for pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery (iNO group). The group was compared with a control group of 65 patients who developed pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery and received conventional therapy from April 2014 to March 2017. Intraoperative hemodynamic changes and postoperative Sequential Organ Failure Assessment (SOFA) score were evaluated.

Results

The inhalation of nitric oxide lowered the pulmonary-to-systemic pressure ratio (Pp/Ps) (p < 0.0001) in the iNO group, and this ratio after the inhalation was significantly lower than that in the control group (p = 0.015). Moreover, norepinephrine requirement was lower in the iNO group than in the control group (p = 0.0060). The SOFA total scores, respiratory scores, coagulation scores, and the increase of renal scores within postoperative 2 days were lower in the iNO group than in the control group (p < 0.0001, p = 0.0002, p = 0.0013, and p = 0.037).

Conclusions

Inhaled nitric oxide therapy ameliorated pulmonary hypertension and improved postoperative respiratory, coagulation, and renal functions in adult valve surgeries.

中文翻译：

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吸入一氧化氮可改善成人心脏瓣膜手术后的肺动脉高压和器官功能

目标

心脏手术期间的肺动脉高压与发病率和死亡率增加有关。吸入一氧化氮作为选择性肺血管扩张剂，并具有其他潜在的肺外保护作用。评估其对成人瓣膜手术后肺动脉高压和器官功能的影响。

方法

2017年4月至2000年3月，30例瓣膜手术（iNO组）体外循环撤机期间肺动脉高压患者接受吸入一氧化氮治疗。该组与对照组65例在瓣膜手术体外循环脱机期间发生肺动脉高压并于2014年4月至2017年3月接受常规治疗的患者进行比较，评估术中血流动力学变化和术后序贯器官衰竭评估（SOFA）评分。

结果

吸入一氧化氮降低了 iNO 组的肺-体循环压力比（Pp/Ps）（p < 0.0001），且吸入后该比值显着低于对照组（p  = 0.015）。此外，iNO 组的去甲肾上腺素需求量低于对照组（p  = 0.0060）。iNO组的SOFA总分、呼吸系统评分、凝血功能评分和术后2天内肾脏评分的增加量均低于对照组（p  < 0.0001，p  = 0.0002，p  = 0.0013，p  = 0.037） .

结论

在成人瓣膜手术中，吸入一氧化氮治疗可改善肺动脉高压并改善术后呼吸、凝血和肾功能。