Influence of inhaled nitric oxide on systemic flow and ventricular filling pressure in patients receiving mechanical circulatory assistance.
Influence of inhaled nitric oxide on systemic flow and ventricular filling pressure in patients receiving mechanical circulatory assistance.
复制标题
吸入一氧化氮对接受机械循环辅助的患者全身血流和心室充盈压的影响。
DOI：
10.1161/01.cir.95.9.2250
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发表时间：
1997
期刊：
影响因子：
37.8
通讯作者：
Couper,GS
中科院分区：
文献类型：
--
作者：
Hare,JM;Shernan,SK;Body,SC;Graydon,E;Colucci,WS;Couper,GS
在左心功能不全的患者中，吸入一氧化氮(NO)可降低肺血管阻力(PVR)，但可能导致临床上左心房压(LAP)的显著升高。这导致了吸入NO可能会到达冠脉循环并产生负性肌力作用的说法。这项研究测试了另一种假设，即LAP增加是因为NO诱导的选择性肺血管扩张导致容量转移到肺静脉间隔。方法和结果Thermo心血管系统HeartMate是一种LV辅助装置(LVAD)，可以设置(通过控制泵速)来提供固定或可变的全身血流。8例患者(LVAD植入后1~11天)吸入NO(20和40ppm，持续10min)，在固定和可变泵流模式下测量LAP、体循环流量和肺动脉压。在两种模式下，吸入NO均使PVR下降(固定模式下降25±6%，P<0.001；可变模式下降21±5%，P<0.003)。固定泵流量时，LAP由12.5±1.2升至15.1±1.4 mm Hg(P<；.008)。在可变流量模式下，LAP没有增加，辅助装置输出量从5.3±0.3 L/min增加到5.7±0.3 L/min(P<0.0 0 8)。结论在不能增加全身血流量的情况下，吸入NO选择性降低PVR可以增加LAP。这些数据支持这样的假设，即在左心衰的情况下，吸入NO通过增加肺静脉容量来增加LAP，并证明吸入NO对LVAD患者具有有益的血流动力学效应。
BackgroundIn patients with left ventricular (LV) dysfunction, inhaled nitric oxide (NO) decreases pulmonary vascular resistance (PVR) but causes a potentially clinically significant increase in left atrial pressure (LAP). This has led to the suggestion that inhaled NO may reach the coronary circulation and have a negative inotropic effect. This study tested an alternative hypothesis that LAP increases because of volume shifts to the pulmonary venous compartment caused by NO-induced selective pulmonary vasodilation.Methods and ResultsThe Thermo Cardiosystems Heartmate is an LV assist device (LVAD) that can be set (by controlling pump rate) to deliver fixed or variable systemic blood flow. Eight patients (between 1 and 11 days after LVAD implantation) were administered inhaled NO (20 and 40 ppm for 10 minutes), and LAP, systemic flow, and pulmonary arterial pressure were measured in both fixed and variable pump flow modes. In both modes, inhaled NO lowered PVR (by 25±6% in the fixed mode,P<.001, and by 21±5% in the variable mode,P<.003). With fixed pump flow, LAP rose from 12.5±1.2 to 15.1±1.4 mm Hg (P<.008). In the variable flow mode, LAP did not increase and the assist device output rose from 5.3±0.3 to 5.7±0.3 L/min (P<.008).ConclusionsA selective reduction in PVR by inhaled NO can increase LAP if systemic flow cannot increase. These data support the hypothesis that with LV failure, inhaled NO increases LAP by increasing pulmonary venous volume and demonstrate that inhaled NO has beneficial hemodynamic effects in LVAD patients.