Hernodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock
Hernodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock
复制标题
DOI：
10.1016/j.jacc.2004.05.047
复制
发表时间：
2004-08-18
影响因子：
24
通讯作者：
Semigran, MJ
中科院分区：
文献类型：
--
作者：
Inglessis, I;Shin, JT;Semigran, MJ
目的：探讨吸入一氧化氮（NO）是否能改善右室心肌梗死（RVMI）合并心源性休克（CS）患者的血流动力学功能。（7名男性和6名女性，年龄65 - 3岁）的心电图，超声心动图，并与RVMI和CS的急性下壁心肌梗死的血流动力学证据进行了研究。给予辅助供氧后（吸入氧分数[FiO 2] = 1.0），分别记录吸入NO前、吸入NO时、吸入NO后（80 ppm，FiO 2 = 0.90）10 min，停止吸入NO后10 min结果吸入NO使平均右心房压降低12 ± 3%，平均肺动脉压降低13 ± 2%，肺血管阻力降低36 ± 8%（均P < 0.05）。吸入一氧化氮使心脏指数增加24 +/- 11%，每搏输出量指数增加23 +/- 12%（p < 0.05）。NO给药不改变全身动脉或肺毛细血管楔压。对比超声心动图确定了3例患者在FiO 2 = 1.0时呼吸时存在卵圆孔未闭和右向左分流。呼吸NO可使分流流量减少56 +/- 5%（p < 0.05），并与全身血氧饱和度显着改善相关。结论：RVMI和CS患者吸入一氧化氮可导致急性血流动力学改善。(C)2004年，美国心脏病学会基金会。
OBJECTIVES We sought to determine whether or not inhaled nitric oxide (NO) could improve hemodynamic function in patients with right ventricular myocardial infarction (RVMI) and cardiogenic shock (CS).BACKGROUND Inhaled NO is a selective pulmonary vasodilator that can decrease right ventricular afterload.METHODS Thirteen patients (7 males and 6 females, age 65 3 years) presenting with electrocardiographic, echocardiographic, and hemodynamic evidence of acute inferior myocardial infarction associated with RVMI and CS were studied. After administration of supplemental oxygen (inspired oxygen fraction [FiO2] = 1.0), hemodynamic measurements were recorded before, during inhalation of NO (80 ppm at FiO2 = 0.90) for 10 min, and 10 min after NO inhalation was discontinued (FiO2, = 1.0).RESULTS Breathing NO decreased the mean right atrial pressure by 12 +/- 3%, mean pulmonary arterial pressure by 13 +/- 2%, and pulmonary vascular resistance by 36 +/- 8% (all p < 0.05). Nitric oxide inhalation increased the cardiac index by 24 +/- 11% and the stroke volume index by 23 +/- 12% (p < 0.05). The NO administration did not change systemic arterial or pulmonary capillary wedge pressures. Contrast echocardiography identified three patients with a patent foramen ovale and right-to-left shunt flow while breathing at FiO2 = 1.0. Breathing NO decreased shunt flow by 56 +/- 5% (p < 0.05) and was associated with markedly improved systemic oxygen saturation.CONCLUSIONS Nitric oxide inhalation results in acute hemodynamic improvement when administered to patients with RVMI and CS. (C) 2004 by the American College of Cardiology Foundation.