ADDITIVE EFFECT ON GAS-EXCHANGE OF INHALED NITRIC-OXIDE AND INTRAVENOUS ALMITRINE BISMESYLATE IN THE ADULT-RESPIRATORY-DISTRESS-SYNDROME
ADDITIVE EFFECT ON GAS-EXCHANGE OF INHALED NITRIC-OXIDE AND INTRAVENOUS ALMITRINE BISMESYLATE IN THE ADULT-RESPIRATORY-DISTRESS-SYNDROME
复制标题
DOI：
10.1007/bf01708960
复制
发表时间：
1994-04-01
影响因子：
38.9
通讯作者：
BROCHARD, L
中科院分区：
文献类型：
--
作者：
WYSOCKI, M;DELCLAUX, C;BROCHARD, L
目的：为了评估吸入一氧化氮（NO）和静脉注射二甲磺酸阿米三嗪（ALM）对气体交换的叠加效应。设计：前瞻性自身对照研究。设置：3个内外科重症监护病房。患者：17例严重低氧血症患者（PaO 2/FIO 2比值：88 +/- 30 mmHg，静脉混合：47 +/-7%）和平均肺动脉压升高（MPAP：30 +/- 5 mmHg）。干预措施：研究了5种情况：1）基线，2）在30分钟期间5至10 ppm的NO，3）在30分钟期间停止NO，4）ALM输注（0.5mg/kg），5）ALM输注（0.5 mg/kg）与5至10 ppm NO组合。测量和结果：NO组PaO 2/FIO 2比值从88 +/- 30上升到98 +/0.37 mmHg（NS），NO + ALM组从92 +/- 25上升到130 +/- 56 mmHg（P < 0.01）（p < 0.05 vs NO）。7例患者被视为“无应答者”（NO时PaO 2/FIO 2比值升高10 mmHg或更高）;在该亚组中，PaO 2/FIO 2比值从87 +/- 30升至128 +/- 39 mmHg 05），以及用NO + ALM从93 +/-20到169 +/-51mmHg（p < 0.01）（p < 0.05相对于单独的NO）。单纯NO组MPAP从30 ± 5降至26 ± 5 mmHg（p < 0.01），单纯ALM组MPAP从28 ± 5升至31 ± 5 mmHg（p < 0.05），NO + ALM组MPAP降至27 ± 5 mmHg（p < 0.05）。单独使用NO的效果很小且不显著，除了在7名患者的亚组中，两种疗法的组合具有更显著的结果。
Objective: To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange.Design: Prospective self-controlled study.Setting: 3 medico-surgical intensive care units.Patients: 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88 +/- 30 mmHg, venous admixture: 47 +/- 7 %) and elevated mean pulmonary artery pressure (MPAP: 30 +/- 5 mmHg) due to adult respiratory distress syndrome (ARDS).Interventions: 5 conditions were studied: 1) baseline, 2) 5 to 10 ppm of NO during 30 min, 3) discontinuation of NO during 30 min, 4) ALM infusion (0.5 mg/kg) during 30 min, 5) ALM infusion (0.5 mg/kg) during 30 min in combination with 5 to 10 ppm of NO.Measurement and results: The PaO2/FIO2 ratio rose from 88 +/- 30 to 98 +/0 37 mmHg (NS) with NO alone, and from 92 +/- 25 to 130 +/- 56 mmHg (P < 0.01) with NO + ALM (p < 0.05 vs NO alone). Seven patients were considered as ''NO-responders'' (rise in PaO2/FIO2 ratio of 10 mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87 +/- 30 to 128 +/- 39 mmHg (P < 0.05) with NO alone, and from 93 +/- 20 to 169 +/- 51 mmHg (p < 0.01) with NO + ALM (p < 0.05 versus NO alone). MPAP decreased from 30 +/- 5 to 26 +/- 5 mmHg (p < 0.01) with NO alone, increased slightly from 28 +/- 5 to 31 +/- 5 mmHg (NS) with ALM alone and decreased to 27 +/- 5 mmHg (p < 0.05) with NO + ALM.Conclusions: NO + ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.