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目的探讨吸入一氧化氮右心导管检查技术评估肺动脉高压患者肺血管储备功能的可行性。方法对36例肺动脉高压患者进行右心导管检查,检测吸入30×10-6NO10分钟前后的肺动脉血流动力学的变化参数,同时与心导管吸氧试验参数、肺组织病理检查结果进行对比研究。结果所有患者在吸入NO过程中无主观不适,心率、血压无明显变化。与基础状态下相比,吸入一氧化氮后,经皮血氧饱和度明显提高(92.65±1.48vs96.03±1.20,P<0.01),肺血管阻力均有明显降低(765.32.±238.57vs352.03.±104.12,P<0.01);与吸氧状态下相比,吸入一氧化氮比吸氧对肺动脉平均收缩压力(82.0±18.45vs45.83±11.85,P<0.01)和肺血管阻力(429.15±193.20vs352.03±104.12,P<0.01)降低的更明显。12例患者手术时肺病理组织检查,7例示轻度肺动脉高压改变(Ⅰ级),2例示中度肺动脉高压改变(Ⅱ级),吸入NO后肺动脉血流动力学参数皆有明显改善,3例Ⅲ→Ⅳ级改变患者各种参数在吸NO前后无明显改善。结论作为评估肺动脉高压患者肺血管储备功能的诊断性手段,右心导管吸入一氧化氮技术具有可行性,安全有效。
Objective To investigate the feasibility of using inhaled nitric oxide right heart catheterization technique to assess pulmonary vascular reserve in patients with pulmonary hypertension. Methods Right heart catheterization was performed in 36 patients with pulmonary hypertension. The parameters of pulmonary arterial hemodynamics before and after inhalation for 30 × 10-6NO10 minutes were measured. At the same time, the parameters of oxygenation test of cardiac catheter and pulmonary pathological examination were compared. Results All patients had no subjective discomfort during inhalation of NO, no significant changes in heart rate and blood pressure. Compared with the basal state, the percutaneous oxygen saturation was significantly increased after inhalation of nitric oxide (92.65 ± 1.48 vs 96.03 ± 1.20, P <0.01), and pulmonary vascular resistance was significantly decreased (765.32 ± 238.57 vs 352). 03. ± 104.12, P <0.01). The mean systolic pressure (82.0 ± 18.45 vs 45.83 ± 11.85, P <0.01) and pulmonary vascular resistance (429.15) of inhaled NO compared with that of oxygen inhaled ± 193.20 vs 352.03 ± 104.12, P <0.01). Pulmonary histopathology was performed in 12 patients. Seven patients showed mild pulmonary hypertension (grade Ⅰ) and two patients showed moderate pulmonary hypertension (Ⅱ grade). Pulmonary arterial hemodynamic parameters were significantly improved after inhalation of NO. Three patients Ⅲ → Ⅳ level changes in patients with various parameters before and after the suction NO no significant improvement. Conclusion As a diagnostic method for evaluating pulmonary vascular reserve in patients with pulmonary hypertension, the right cardiac catheterization of nitric oxide is feasible, safe and effective.