mbt batai Nitric oxide in patients with congenital

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Abstract: OBJECTIVE To investigate the effect of inhaling nitric oxide (NO) on pulmonary surfactant (PS) including the change of concentration and composition with the time in the patients with congenital heart disease complicating pulmonary hypertension. METHODS 34 children with congenital heart disease associated with pulmonary hypertension undergoing heart surgery with extracorporeal circulation (ECC) were randomly divided into two groups : inhaled NO group and control group. The bronchoalveolar lavage fluid (BALF) was obtained for analyzing content of total phospholipids (TPL), saturate phosphatidy choline (SPC), total protEin (TP) and the oxygenation index (QI) before and after surgery at 30 min, 2 h and 6 h. RESULTS The PS activity was decreased and the QI was increased significantly after ECC in both the control group and inhaled NO group. The PS activity in the inhaled NO group was markedly decreased compared with the control group after ECC at 2 h and 6 h (P 0.05). There were no significant differences in the oxygenation index between the two groups (P> 0.05) .CONCLUSION ECC reduces pulmonary surfactant activity signifficantly. The pulmonary surfactant was lower after exogenous inhaled NO. There were no significant effects on respiratory function after ECC.
1.4 two samples were collected before surgery, after intubation, postoperative mechanical ventilation 30 min, 2 h, 6 h, the airway by endotracheal intubation to obtain aspirate. Sterile thin silicone tube, one end of suction device, in an indirect sterile bottles, and the other end into the airway, inserted into the trachea bifurcation below so that the airway aspirate collected in a sterile bottle. About 2 ~ 3 ml, centrifuged supernatant, set -80 ℃ measured PS levels to be saved. Synchronized at all time points for blood gas analysis.

1.3 INO ventilation mode and with intermittent positive pressure ventilation inhalation, positive end expiratory pressure (PEEP) 5 cmH2O, VT 8 ml / kg, adjust the respiratory rate to tidal carbon dioxide partial pressure was maintained at 40 50 mmHg. INO group after surgery inhaled NO, inhaled concentration of 10 ~ 15 ppm (1ppm = 10-6mmol / L), the average inhalation time of 8 h,[link widoczny dla zalogowanych], monitoring of NO2 in the concentration of inhalation therapy, does not meet the alarm value of the machine; at 8 h after the disabled NO therapy, gradually reduce the dosage used, the transition to mechanical ventilation. Control group intravenous nitroprusside infusion pump therapy, the concentration of sodium nitroprusside infusion of 3 ~ 6 μg / (kg · min), the average treatment time of 36 h.
1 Materials and methods
1.2 ECC anesthesia and endotracheal tube after induction of anesthesia, intravenous anesthesia with mechanical ventilation and intermittent inhalation en / maintenance of anesthesia with isoflurane. Adopt sternal incision, after heparin, the establishment of ECC, using the artificial heart-lung machine Stocket S Ⅲ and membrane oxygenation, moderate hemodilution (Hct 0.20 ~ 0.30). Bypass to maintain ACT 480 s or more, shut down after the 1:1 in the protamine and heparin. Intraoperative monitoring of arterial pressure, central venous pressure (CVP), nasopharyngeal, rectal temperature, blood gas, electrolytes, infusion pump and so on.
Nitric oxide in patients with congenital heart disease of pulmonary surfactant

Abstract Objective congenital heart disease patients, especially after surgery in patients with pulmonary hypertension by inhaled nitric oxide, the bronchoalveolar lavage fluid in pulmonary surfactant (PS) concentration, composition changes,[link widoczny dla zalogowanych], and with the Inhalation time and place change. Methods 34 patients with congenital heart disease with pulmonary hypertension and implementation of cardiopulmonary bypass in children were randomly divided into INO group (exogenous NO inhalation in the treatment group) and control group in 17 cases. Before and after surgery were 30 min, 2 h, 6 h in the bronchoalveolar lavage fluid total phospholipids, saturated lecithin, total protein content and calculated oxygenation index. The results of the two groups after CPB were significantly reduced PS, oxygenation index. After 2 h, 6 h after the INO group PS was significantly lower than the control group (P 0.05). Conclusions PS can significantly reduce the level of CPB,[link widoczny dla zalogowanych], the application of exogenous NO to further reduce the PS level, but no significant effect on respiratory function. Chinese papers League finishing.
1.5 Experimental monitoring of blood gas and electrolyte testing by the Nova Stat Profile blood gas analyzer monitoring. Data by the Servo ventilator300A Respiratory Monitoring System Respiratory collection. Determination of inspired oxygen ventilation (FiO2), mean airway pressure (MP, cmH2O), blood gas analyzer partial pressure of oxygen (PaO2), using the formula: oxygenation index (OI) = FiO2 × MP × 100 / PaO2, calculated the oxygenation index.
Key words: Nitric oxide; Extracorporeal circulation; Pulmonary surfactant; Bronchoalveolar lavage fluid; Pulmonary hypertension
1.6 lavage fluid biochemical determination of ammonia naphthalene sulfonic acid method, respectively (Bartlett method), four hungry after the reaction of neutral aluminum oxide column chromatography (Mason Law) and modified Folin phenol reagent method (Lowry method) determination of total phospholipid (TPL), saturated phosphatidylcholine (SatPC) and total protein (TP) concentration, to correct for lavage dilution of the different levels of PS due to bias, take SatPC / TPL and SatPC / TP ratio as an indicator to determine the level of PS activity.

1.1 General clinical data selected from May 2004 to December 2006 in patients with congenital heart disease with pulmonary hypertension in 34 patients, 19 males and 15 females cases; aged 6 months to 17 years of age; weight of 4.5 ~ 39 (13.4) kg; of which 20 cases of ventricular septal defect, atrial septal defect in 7 cases, 2 cases of patent ductus arteriosus, complex deformity in 5 cases. Preoperative echocardiography, cardiac catheterization and clinical signs are clear and severe pulmonary hypertension, mean pulmonary artery pressure 59 mmHg. Randomly divided into two groups, each group 17 cases,[link widoczny dla zalogowanych], other conditions are relatively fixed, while a group of mechanical ventilation inhaled NO therapy (INO group), while another group of mechanical ventilation, intravenous sodium nitroprusside treatment (control group).

inhaled nitric oxide (inhaled nitric oxide, INO) can reduce pulmonary artery pressure, intrapulmonary shunt and improve oxygenation to reduce the role. INO during cardiopulmonary bypass (extracorporeal circulation, ECC) after lung compliance and pulmonary surfactant (PS) the impact needs further study. In this paper, patients with congenital heart disease with pulmonary hypertension was observed after surgery by the INO in bronchoalveolar lavage fluid concentrations of PS, composition changes, and with the inhalation of time the change occurred, and explore its impact on respiratory function.

1.7 SPSS 11.5 statistical analysis software application for data analysis, all data is expressed as (± s), group single factor analysis of variance between groups using t test. P <0.05 for the difference was statistically significant.

bypass Key words Nitric oxide surfactant in bronchoalveolar lavage fluid of pulmonary hypertension

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