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目的 观察吸入一氧化氮（ＮＯ）、静注前列腺素Ｅ１ 及米力农对心脏瓣膜置换术患者体外循环后早期肺高压的治疗作用，并比较它们对血液动力学和肺内分流率（ＱＳ／ＱＴ）的影响。方法 选择瓣膜病合并肺高压瓣膜置换术患者３１例，主动脉插管拔除后５分开始用药治疗。随机分为三组：吸入ＮＯ（Ｎ组，９例），静注前列腺素Ｅ１ （Ｐ组，１０ 例），静注米力农（Ｍ 组，１２例）。采用Ｓｗ ａｎ－Ｇａｎｚ导管技术测定血液动力学参数，取桡动脉和肺动脉血标本测血气值和血红蛋白，根据血气结果计算ＱＳ／ＱＴ。结果 Ｎ组：吸入ＮＯ ３０ｐｐｍ １５ 分ＭＰＡＰ和ＰＶＲＩ显著降低（Ｐ＜ ０．０１），停吸１５分，回复至高于吸入前值。Ｐ组和Ｍ 组：用药１５ 分、３０ 分和６０ 分，ＭＰＡＰ和ＰＶＲＩ均显著降低（Ｐ＜ ０．０５ 或０．０１）。Ｐ组用药３０分、６０分和Ｍ 组用药３０ 分，ＣＶＰ显著降低（Ｐ＜ ０．０５）。Ｍ 组用药１５ 分、３０ 分和６０ 分时ＰＣＷＰ均显著降低（Ｐ＜ ０．０５）。三组用药ＣＩ的增加Ｍ 组＞ Ｐ组＞ Ｎ组，Ｍ 组心率增快（７～９）％ 。用药１５分，ＱＳ／ＱＴＮ组降低１４％ ，Ｐ组基本不变，Ｍ 组增加１５％ 。结论 三种药物均能选择性扩张肺血管。ＮＯ不影响体
Objective To observe the therapeutic effects of inhaled nitric oxide (NO), intravenous prostaglandin E1 and milrinone on pulmonary hypertension after cardiopulmonary bypass in patients undergoing heart valve replacement and to compare their effects on hemodynamics and pulmonary shunt (QS / QT) effect. Methods Thirty-one patients with valvular disease complicated with pulmonary valve replacement were enrolled in this study. Medication was started 5 minutes after the aortic catheter was removed. Randomly divided into three groups: inhaled NO (N group, 9 cases), intravenous prostaglandin E1 (P group, 10 cases), intravenous Milrinone (M group, 12 cases). Hemodynamic parameters were determined using the Swan-Ganz catheter technique. Blood gases and hemoglobin were taken from radial and pulmonary arterial blood samples, and QS / QT was calculated from blood gas results. Results In group N, NO 30ppm inhalation 15 minutes MPAP and PVRI significantly decreased (P <0.01), stop breathing for 15 minutes and returned to higher than before inhalation. P group and M group: MPAP and PVRI were significantly decreased (P <0.05 or 0.01) at 15, 30 and 60 minutes. P group 30 minutes, 60 minutes and M group 30 minutes, CVP was significantly lower (P <0.05). In group M, PCWP was significantly decreased at 15, 30 and 60 minutes (P <0.05). Three groups of drug CI increased M group> P group> N group, M group heart rate increased (7 ~ 9)%. The medication 15 minutes, QS / QTN group decreased by 14%, P group basically unchanged, M group increased by 15%. Conclusion All three drugs can selectively expand the pulmonary vessels. NO does not affect the body