Inhaled nitric oxide variably improves oxygenation and pulmonary hypertension in patients with acute respiratory distress syndrome.
Inhaled nitric oxide variably improves oxygenation and pulmonary hypertension in patients with acute respiratory distress syndrome.
复制标题
吸入一氧化氮可不同程度地改善急性呼吸窘迫综合征患者的氧合和肺动脉高压。
DOI：
10.1097/00005373-199509000-00004
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Fullerton,DA
中科院分区：
文献类型：
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作者：
McIntyreJr,RC;Moore,FA;Moore,EE;Piedalue,F;Haenel,JS;Fullerton,DA
本研究的目的是确定吸入一氧化氮（NO）对成人呼吸窘迫综合征（ARDS）患者氧合、血流动力学和通气的影响。方法对14例ARDS患者（年龄42.9 ± 6）进行了16次吸入NO试验，这些患者具有显著的肺动脉高压（平均肺动脉压> 30 mm Hg）。用动脉和肺动脉导管监测患者。按照严格的方案进行容量通气。在基线和20和40 ppm NO后30分钟收集数据。结果总体而言，PaOsub 2/FIOsub 2比率在20 ppm时从69.5+/-3.9增加到100.8+/-9.5，增加42.9+/-8.7%，在40 ppm时增加到97.7+/-13.1。较基线增加44.1+/-14.2%（p= 0.001）。然而，16项试验中有5项表现出轻微改善（PaOsub 2/FIOsub 2比值增加< 20%），5项中度改善（20-50%），6项显著改善（> 50%）。总体而言，平均肺动脉压（MPAP）从41.1+/-1.8 mmHg降至20 ppm时的34.3+/-1.3 mmHg和40 ppm时的33.5+/-1.8 mmHg，降低15.0+/-3.7%，p= 0.002。然而，16项试验中有5项表现出轻微改善（MPAP降低< 10%），7项中度改善（10-20%），4项显著改善（> 20%）。在40 ppm NO时，4名在20 ppm NO时MPAP中度改善的患者有明显改善。在20或40 ppm时，全身氧输送和消耗、肺内分流或肺顺应性均无变化（p> 0.05）。在收集这些数据后，14名患者中的10名进行了4.5+/-0.7天（范围1-10天）的延长NO吸入（2-20 ppm）。总体而言，有7例死亡（死亡率50%）。在接受长期NO的患者中，有3例死亡（死亡率30%）。所有4例患者谁未能响应吸入NO随后死亡（死亡率100%）。结论吸入NO改善氧合和肺血流动力学在ARDS患者。然而，对NO的改善是可变的。
ObjectiveThe purpose of this study was to determine the effect of inhaled nitric oxide (NO) on oxygenation, hemodynamics, and ventilation in patients with adult respiratory distress syndrome (ARDS).MethodsSixteen trials of inhaled NO were performed in 14 ARDS patients (age 42.9+/-6) who had significant pulmonary hypertension (mean pulmonary artery pressure> 30 mm Hg). Patients were monitored with arterial and pulmonary artery catheters. Volume ventilation was performed by a strict protocol. Data were collected at baseline and 30 minutes after 20 and 40 ppm NO.ResultsOverall, the PaOsub 2/FIOsub 2 ratio increased from 69.5+/-3.9 to 100.8+/-9.5 at 20 ppm, a 42.9+/-8.7% increase, and to 97.7+/-13.1 at 40 ppm, a 44.1+/-14.2% increase over baseline (p= 0.001). However, 5/16 trials demonstrated minimal improvement (PaOsub 2/FIOsub 2 ratio increase< 20%), 5 moderate improvement (20-50%), and 6 marked improvement (> 50%). Overall the mean pulmonary artery pressure (MPAP) decreased from 41.1+/-1.8 mm Hg to 34.3+/-1.3 at 20 ppm and 33.5+/-1.8 mm Hg at 40 ppm, a 15.0+/-3.7% decrease, p= 0.002. However, 5/16 trials demonstrated minimal improvement (MPAP decrease< 10%), 7 moderate improvement (10-20%), and 4 marked improvement (> 20%). At 40 ppm NO, 4 patients with moderate improvement in MPAP at 20 ppm NO had marked improvement. There were no changes in systemic oxygen delivery and consumption, intrapulmonary shunt, or lung complicance at 20 or 40 ppm (p> 0.05). Following collection of these data, prolonged NO inhalation (2-20 ppm) was done in 10 of 14 patients for 4.5+/-0.7 days (range 1-10 days). Overall, there were 7 deaths (mortality 50%). In patients receiving prolonged NO, there were 3 deaths (mortality 30%). All 4 patients who failed to respond to inhaled NO subsequently died (mortality 100%).ConclusionsInhaled NO improves oxygenation and pulmonary hemodynamics in patients with ARDS. However, the improvement to NO is variable.