一氧化氮吸入对感染性休克并发急性呼吸窘迫综合征患者氧合功能的作用及血流动力学的安全性研究

Study on the effects of nitric oxide inhalation on the improvement of oxygenation and hemodynamic status in patients with septic shock complicated with acute respiratory distress syndrome

目的 :评估吸入低浓度一氧化氮 (NO)治疗感染性休克并发急性呼吸窘迫综合征 (ARDS)患者的有效性及对患者血流动力学的影响。方法 :对 17例感染性休克并发 ARDS患者行机械通气 ,Swan Ganz导管检查 ,观察吸入 10 m mol/ L NO前后氧合功能和血流动力学的变化。结果 :吸入 NO后 ,患者动脉血氧分压、血氧饱和度及氧合指数分别由 (8.6 7± 2 .15 ) k Pa(1k Pa=7.5 mm Hg) ,0 .86± 0 .0 8和 (9.6 3± 3.0 7) k Pa上升至(17.74± 8.82 ) k Pa,0 .95± 0 .0 8和 (2 5 .33± 11.36 ) k Pa(P均 <0 .0 0 1) ;肺内分流率由 (4 7.4± 13.3) %下降至(2 8.1± 12 .7) % (P<0 .0 0 1) ;血流动力学参数 :平均动脉压、平均肺动脉压、心输出量、心脏指数、体肺循环阻力指数、中心静脉压及肺动脉楔压均无明显变化 (P均 >0 .0 5 )。结论 :吸入低浓度 NO对感染性休克并发ARDS患者的氧合功能、血气指标有明显改善且血流动力学稳定 。

Objective:To assess the therapeutic effects of nitric oxide(NO) inhalation on septic shock complicated with acute respiratory distress syndrome (ARDS) and its impact on hemodynamics.Methods:Seventeen patients with septic shock complicated with ARDS underwent mechanical ventilation and SwanGanz catheterization.Hemodynamic parameters were monitored and blood gas analysis was performed before and after inhalation of 10 mmol/L NO.Results:After NO inhalation,PaO 2,arterial oxygen saturation(SaO 2) and PaO 2/FiO 2 increased from (8 67±2 15)kPa (1 kPa=7 5 mmHg),0 86±0 08 and (9 63±3 07)kPa to (17 74±8 82)kPa,0 95±0 08 and (25 33±11 36)kPa respectively (all P<0 001).Intrapulmonary shunt ratio(s/t) significantly decreased from (47 4±13 3)% to (28 1±12 7)%(P<0 001).Hemodynamic parameters (MBP,MPAP,CO,CI,CVP,PAWP,SVRI,PVRI) showed no significant changes before and after NO inhalation (all P>0 05).Conclusions:Low dose NO inhalation is effective and safe in the treatment of septic shock complicated with ARDS.