多巴酚丁胺对吸入NO降低缺氧性肺动脉高压作用量效关系的研究

The study of dose response effects of dobutamine on the action of inhaled nitric oxide decreasing hypoxic pulmonary hypertension

目的 探讨不同剂量多巴酚丁胺 ( DOB)对吸入 NO治疗作用的影响。方法 健康杂种犬 8只 ,麻醉后建立血液动力学和呼吸气体监测 ,控制呼吸 ,吸入气体由 O2 、N2 和含 NO组成。每只犬随机先静脉用 DOB和先吸入 NO两组进行实验。先静滴 DOB时 ,按随机顺序分别自股静脉泵入 0、5、10、15μg· kg- 1 · min- 1 DOB,然后降低 Fi O2 至 0 .12 ,待 PAP稳定后随机顺序吸入 4 0× 10 - 6NO和90× 10 - 6NO,记录各步骤之后血液动力学参数。先吸 NO时 ,缺氧 ,吸入 90× 10 - 1 NO,再按随机顺序先后静滴 DOB 5 ,10 ,15μg· kg- 1 · min- 1 ,观察各步骤稳定后血液动力学参数。以缺氧时所测的参数为基础值 ,计算各步骤稳定后参数值的变化百分率。结果 不管吸入 NO和静注 DOB顺序先后 ,当静注 DOB速率为 ,5 μg· kg- 1· min- 1和 10 μg· kg- 1· m in- 1时 ,并不显著影响 NO吸入为 4 0× 10 - 6和90× 10 - 6的治疗效果 ( P<0 .0 5 )。当 DOB速率为 15 μg· kg- 1· min- 1时 ,则明显削弱吸入 NO降低肺动脉压 ( MPAP)和肺循环 ( PVR)的作用 ( P<0 .0 1) ,同时显著增加 CO、MAP和体循环阻力 ( SVR)。结论 DOB剂量小于 10μg· kg- 1 · min- 1 时 ,并不影响吸入 NO的治疗作用。因此 。

Objective To determine the effects of different dose of dobutamine on the pulmonary vasodilative action when inhaled NO in hypoxic pulmonary hypertension dogs.Methods Eight healthy dogs respiration was controlled with ventilator inhaling the O 2 N 2 NO mixture.The hemodynamics and gases were monitored and recorded.The experiment was carried out in two ways:NO inhaled after dobutamine was administered (EXP A),and dobutamine was infused during NO inhalation (EXP B).In EXP A:dobutamine of 0,5,10,15μg·kg -1 ·min -1 was continously infused in randomized order.When effects of dobutamine was stable FiO 2 was decreased to 0.12.After PAP increased and stable,40ppm and 90ppm NO were inhaled.The effect of NO on hemodynamics was observed.In EXP B:when FiO 2 decreased to 0.12 and PAP was stable,90ppm NO was inhaled.After the greatest effects was reached,dobutamine of 5,10,15μg·kg -1 ·min -1 was infused.Results dobutamine of 5,10μg·kg -1 ·min -1 didn`t significantly influence the effects of vasodilative action of inhaled 40ppm and 90ppm NO (P>0 05) Dobutamine of 15μg·kg -1 ·min -1 obviously decreased both mPAP and PVR while CO,MAP and SVR increased significantly.Conclusion It is ideal treatment choice that inhaled NO in conjunction with infused lower dose of dobutamine during cardiac operation complicating with hypoxic pulmonary hypertension.