一氧化氮治疗急性呼吸窘迫综合征的疗效观察

Observation on effects of nitric oxide in patients with acute respiratory distress syndrome

目的：观察吸入一氧化氮（ＮＯ）治疗急性呼吸窘迫综合征（ＡＲＤＳ）时对其血流动力学和气体交换的影响。方法：选择８例ＡＲＤＳ患者，吸入０．００３％的ＮＯ，观察３个时相点：（１）基础值；（２）开始吸入ＮＯ后２０分钟；（３）停止吸入ＮＯ后２０分钟。结果：吸入ＮＯ使平均肺动脉压从（３．７３±０．６３）ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）下降至（３．２０±０．５３）ｋＰａ（Ｐ＜０．０１），使肺血管阻力指数从（４０．６±６．３）ｋＰａｓＬ－１ｍ２下降至（３１．１±４．７）ｋＰａｓＬ－１ｍ２（Ｐ＜０．０１），而体循环指标无明显变化；与此同时，动脉血氧分压从（９．０７±２．２７）ｋＰａ上升至（１１．６０±２．８０）ｋＰａ（Ｐ＜０．０１），动脉血氧含量从（１２２±２１）ｍｌ／Ｌ上升至（１２８±２０）ｍｌ／Ｌ（Ｐ＜０．０１），动脉氧供应指数从（３８６±８９）ｍｌｍｉｎ－１ｍ－２增加至（４３７±９９）ｍｌｍｉｎ－１ｍ－２（Ｐ＜０．０１），而肺泡动脉氧分压差从（４１．３０±４．２７）ｋＰａ下降至（３８．５０±５．３３）ｋＰａ（Ｐ＜０．０１），肺内分流率从０．３４±０．０５下降至０．２９±０．０４（Ｐ＜０．０１）；停止吸入ＮＯ２０分钟后?

Objective:To assess the effects of inhaled nitric oxide (NO) on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS).Methods:Eight patients with ARDS were enrolled in our study,time points were observed as follows:baseline,twentieth minute after beginning 0 003% NO inhalation,and twentieth minute after stopping NO inhalation.Results:Inhaled NO reduced mean pulmonary artery pressure from(3 73±0 63)kPa(1 kPa=7 5 mmHg) to(3 20±0 53)kPa( P <0 01) and pulmonary vascular resistance index from (40 6±6 3) kPa·s·L -1 ·m 2 to (31 1±4 7) kPa·s·L -1 ·m 2 ( P <0 01).Meanwhile,arterial oxygen partial pressure rose from(9 07±2 27) kPa to (11 60±2 80)kPa ( P <0 01),oxygen content from(122±21)ml/L to(128±20)ml/L( P <0 01),and oxygen availability index from(386±89)ml·min -1 ·m -2 to(437±99)ml·min -1 ·m -2 ( P <0 01).However,alveolararterial oxygen difference decreased from(41 30±4 27) kPa to(38 50±5 33)kPa ( P <0 01),and pulmonary venous admixture from 0 34±0 05 to 0 29±0 04( P <0 01).At twentieth minute after stopping NO inhalation,all parameters above returned to the levels prior to NO inhalation.During observation period,heart rate,mean systemic artery pressure,pulmonary artery wedge pressure,central venous pressure,cardiac index and systemic vascular resistance index had no significant changes.Conclusions:Inhaled NO can selectively dilate the pulmonary artery and is very beneficial to the patients with ARDS.