2026 年第 10 期 第 21 卷

急性A型主动脉夹层术后严重低氧血症患者吸入低剂量一氧化氮的早期疗效分析

Analysis of early-stage efficacy of inhaled low-dose nitric oxide in patients with severe hypoxemia after surgery for acute type A aortic dissection

作者：时亚丽金祺刘楠王红贾明侯晓彤

英文作者：Shi Yali Jin Qi Liu Nan Wang Hong Jia Ming Hou Xiaotong

单位：首都医科大学附属北京安贞医院心脏外科危重症中心北京市心肺血管疾病研究所,北京100029

英文单位：Center for Cardiac Surgical Critical Care Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：主动脉夹层；术后低氧血症；吸入性一氧化氮；氧合指数

英文关键词：Aorticdissection;Postoperativehypoxemia;Inhalednitricoxide;Oxygenationindex

• 摘要：

• 目的  探讨低剂量吸入性一氧化氮（iNO）治疗急性A型主动脉夹层（ATAAD）术后严重低氧血症的临床效果及安全性。方法 回顾性收集首都医科大学附属北京安贞医院2023年11月至2025年10月收治的ATAAD术后48 h内发生严重低氧血症［动脉血氧分压（PaO2）/吸入氧浓度（FiO2）≤100 mmHg（1 mmHg=0.133 kPa）］的患者资料，将2024年8月之前予以常规治疗的患者作为对照组，2024年8月之后在常规治疗基础上予以吸入低剂量一氧化氮（5～10 ppm）治疗的患者作为iNO组。比较2组患者治疗前后PaO2/FiO2变化、机械通气时间、重症监护病房（ICU）住院时间、并发症及不良反应发生情况。结果 共纳入87例患者，其中iNO组48例，对照组39例。治疗6、12、24、48、72 h时点iNO组PaO2/FiO2均显著高于对照组［（143±40）mmHg比（119±29）mmHg、（139±41）mmHg比（120±26）mmHg、（145±43）mmHg比（112±23）mmHg、（158±45）mmHg比（124±36）mmHg、（168±57）mmHg比（131±36）mmHg］（均P＜0.05）。iNO组机械通气时间、ICU住院时间均短于对照组，气管切开率显著低于对照组（均P＜0.05）。2组术后因出血导致二次开胸探查的发生率及连续性肾脏替代治疗发生率差异均无统计学意义（均P＞0.05）。结论 低剂量iNO可有效改善ATAAD术后低氧血症患者的氧合状态，缩短机械通气时间和ICU住院时间，减少气管切开率，且安全性良好。

• Objective To investigate the clinical efficacy and safety of low-dose inhaled nitric oxide (iNO) for severe hypoxemia after acute type A aortic dissection (ATAAD) surgery. Methods Clinical data of patients who developed severe hypoxemia［partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤100 mmHg］within 48 h after ATAAD surgery admitted to Beijing Anzhen Hospital, Capital Medical University from November 2023 to October 2025 were retrospectively collected. Patients receiving conventional therapy before August 2024 were assigned to the control group, and those treated with low-dose inhaled nitric oxide (5-10 ppm) on the basis of conventional therapy after August 2024 were assigned to the iNO group. Changes in PaO2/FiO2 before and after treatment, duration of mechanical ventilation, intensive care unit (ICU) length of stay, complications and adverse reactions were compared between the two groups. Results A total of 87 patients were enrolled, including 48 in the iNO group and 39 in the control group. PaO2/FiO2 in the iNO group was significantly higher than that in the control group at treatment 6, 12, 24, 48 and 72 h ［(143±40)mmHg vs (119±29)mmHg, (139±41)mmHg vs (120±26)mmHg, (145±43)mmHg vs (112±23)mmHg, (158±45)mmHg vs (124±36)mmHg, (168±57)mmHg vs (131±36)mmHg］(all P＜0.05). The duration of mechanical ventilation and ICU length of stay were shorter, and the tracheotomy rate was significantly lower in the iNO group (all P＜0.05). There were no statistically significant differences in the incidence of re-exploration for postoperative bleeding and continuous renal replacement therapy between the two groups (both P＞0.05). Conclusion Low-dose iNO can effectively improve oxygenation status in patients with hypoxemia after ATAAD surgery, shorten mechanical ventilation time and ICU length of stay, reduce tracheotomy rate, with favorable safety profile.