一氧化氮吸入治疗急性呼吸窘迫综合征的临床观察

Changes of airway responsiveness, and relative factors in asthmatics with remission at puberty

目的探讨吸入一氧化氮（ＮＯ）对急性呼吸窘迫综合征（ＡＲＤＳ）的作用。方法１０例患者行机械通气、漂浮导管，观察吸入３５ｐｐｍＮＯ前后血液动力学、血气和血氧运输的变化。结果吸入ＮＯ后，患者平均肺动脉压和肺循环阻力分别由３６±０６ｋＰａ和３２±１１ｋＰａ·ｓ１Ｌ１下降至２７±０５ｋＰａ和２２±９ｋＰａ·ｓ１·Ｌ１（Ｐ均＜０００１），心排血量、血压及体循环阻力无明显变化；肺内分流率和肺泡动脉氧分压差分别由３１％±９％和３７±６ｋＰａ下降至２５％±８％和３４±６ｋＰａ（Ｐ＜００１），动脉血氧分压和血氧饱和度均有上升。

Objective To study the airway responsiveness and relative factors in asthmatics with natural remission at puberty. Method The airway responsiveness was evaluated by challenge of methacholine (PC20), blood sIL 2R, eosinophil count, basophil count and basophil releasability were detected in 18 asthmatics with remission at puberty (group Ⅰ), in 20 asthmatics without remission at puberty (group Ⅱ),and in 30 healthy controls(group Ⅲ). Result The mean value of PC20 in the group Ⅰwas significantly lower than that of the group Ⅲ (P<0 01), but still higher than that of the group Ⅱ (P<0 01). The blood sIL 2R and eosinophil values weredroped almost to those of the group Ⅲ, significantly lower than those of the group Ⅱ. The basophil value and positive rate of human basophil degranulation test stimulated by mannitol with hyperosmolarity were still abnormal, significantly higher than those of the group Ⅲ, and the basophil level was significantly related to the airway responsiveness.Conclusion The asthmatics with remission at puberty have a certain degree of airway hyperresponsivenes that is related to the abnormal of basophil.