外源性一氧化氮吸入治疗急性呼吸窘迫综合征

Inhaled extrinsic nitric oxide to treat ARDS

目的 探讨对于急性呼吸窘迫综合征 (ARDS)病人采用吸入外源性一氧化氮 (NO)治疗引起血流动力学和呼吸功能的改变。方法 8例ARDS患者行机械通气、漂浮导管 ,吸入NO 2 0ppm ,观察 3个时相点 :①基础水平 ;②开始吸入NO后 2 0min ;③停止吸入NO后 2 0min ;④血流动力学、血气和肺内分流量的变化。结果 吸入NO后 ,患者平均肺动脉压 (MPAP)从 (3 74± 0 6 4 )kPa下降至 (2 6 1± 0 5 1)kPa(P <0 0 1) ,而平均动脉压 (MAP)、肺毛细血管楔压及中心静脉压无明显变化 ;同时 ,动脉血氧分压、动脉血氧饱和度分别从 (10 3± 1 81)kPa和 (93 4± 3 3) %上升至 (11 8± 1 0 7)kPa和 (96 0± 2 3) % (P <0 0 5 ,P <0 0 1) ,而肺内分流量从 (30 8± 7 4 ) %下降至 (2 3 5± 3 5 ) % (P <0 0 1) ;停止吸入NO 2 0min后 ,各指标又基本恢复至基础水平。结论 吸入外源性NO具有较好的肺血管扩张选择性 。

Objective To investigate the effects of nitric oxide (NO) in dynamic and gas exchange of acute respiratory distress syndrome (ARDS).Methods For eight patients with ARDS underwent Swan-Ganz catheterization and mechanical ventilation,we examined hemodynamic,blood gas and Qs/Qt parameters in basic level,twenty minutes after inhaling 20 ppm NO and twenty minutes after stopping inhalation of 20 ppm NO.Results After inhaling NO,MPAP were significantly reduced from(3 74±0 64) kPa to (2 61±0 51) kPa(P<0 01).MAP,PCWP, and CVP were not significantly different;Meanwhile PaO 2 and SaO 2 were increased from (10 3±1 8) kPa to (11 8±1 07) kPa and from (93 4±3 3)% to (96 0±2 3)% respectively (P<0 05,P<0 01);Qs/Qt were decreased from (30 8±7 4)% to (23 5±3 5)% (P<0 01);Twenty minutes after stopping inhalation,all data basically resume to basic level.Conclusion NO have better alternative in dilatation of pulmonary blood vessel.It can decreased pulmonary artery pressure and improve the function of gas exchange.