硝普钠雾化吸入对肺动脉高压的影响

Effects of aerosolized sodium nitroprusside inhalation on pulmonary arterial pressure

目的:观察硝普钠(SNP)雾化吸入对肺动脉高压的影响。方法:选择慢性肺源性心脏病肺动脉高压病人20例,静息30分钟,用惠普5500型心脏超声仪测量肺动脉压(PAP)、左心室射血分数(LVEF),用水银柱血压计测量肱动脉平均压(MAP),而后行生理盐水雾化吸入20分钟,停吸10分钟;再行SNP雾化吸入(SNP50mg+生理盐水50ml)20分钟;分别于两者吸入5分钟、10分钟、15分钟、20分钟以及停吸5分钟、10分钟时测量上述各项指标,然后进行比较分析。结果:生理盐水雾化吸入全程各指标无明显变化,SNP雾化吸入5分钟时,PAP由66.76±10.24mmHg降至56.44±11.22mmHg(P<0.01);LVEF由0.50±0.04%升至0.56±0.06%(P<0.01);10分钟时,PAP继续下降至53.26±10.62mmHg(与5分钟比较P<0.05);LVEF继续上升至0.58±0.06%(与5分钟比较P<0.05);吸入至20分钟,PAP、LVEF与10分钟比较无明显变化;停止吸入5分钟,PAP即回升至63.22±10.44mmHg、LVEF降至0.53±0.04%(P均<0.01);停吸100分钟均恢复至吸入前的状态;MAP全程无明显变化。结论:硝普钠雾化吸入可明显降低肺动脉压,提高左心室射血分数,对平均动脉压无明显影响。

Objective: To investigate the effects of aerosolized sodium nitroprusside (SNP) inhalation on pulmonary arterial pressure. Methods: Twenty patients with chronic obstructive pulmonary disease (COPD) after having a rest for 30 minutes, were measured with pulmonary arterial pressure (PAP), left ventricular ejection fraction (LVEF) and mean arterial pressure (MAP). After inhaled aerosolized normal saline (NS) for 20 min, and cut out for 10 min. again inhaled aerosolized SNP for 20 min, at 5, 10, 15, 20 min and after stopping 5, 10 min, aforementioned indexes were measured separately, Results: During acrosolized NS inhalation, every index didn't change obviously: When aerosolized SNP inhalation 5 min, PAP fell from 66. 76±10. 24 mmHg to 56. 44±11. 22 mmHg. LVEF rose from (0.50±0.04)% to (0.56 ± 0.06)% (P<0. 01). When aerosolized SNP inhalation 10 min, PAP fell to 53. 26 ± 10. 62mmHg, LVEF rose to (0. 58±0. 06)%. Inhalation continuing, LVEF and PAP didn't change obviously. At 5 rnin after stopping. PAP again rose to 63. 22±10. 44mmHg; LVEF again fell to (0.53±0.04)%. At 10 min after stopping, PAP and LVEF resumed to original level. MAP didn't change obviously during inhalation. Conclusion: Aerosolized SNP can reduce PAP, raises LVEF, and don't influence on MAP.