Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation
Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation
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DOI：
10.1093/bja/aei194
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发表时间：
2005-09-01
影响因子：
9.8
通讯作者：
Puig, MM
中科院分区：
文献类型：
--
作者：
Silva-Costa-Gomes, T;Gallart, L;Puig, MM
背景资料。阿米替林联合吸入一氧化氮(NO)可预防单肺通气(OLV)过程中的缺氧。在开胸行OLV期间，阿米替林的最佳剂量尚未确定，该剂量将提供治疗优势且副作用较少。42例开胸手术患者随机分为3组：安慰剂组、阿米替林4mgkg(-1)min(-1)和吸入NO10p.m。(ALM4+NO)，阿米替林16 mg·kg~(-1)min(~(-1))，吸入NO 10 ppm。(ALM 16+NO)。监测气体交换、血流动力学和呼吸变量以及血浆阿米特林和乳酸浓度。分别于患者清醒时(基线)、双肺通气诱导后(对照2LV)、治疗后20min(2LV+T)、OLV(OLV10‘、OLV20’和OLV30‘)分别于麻醉诱导后10min、20min和30min用FI(O2)I进行测量。在安慰剂组，OLV降低了PaO2，增加了肺分流[16(SD 7)kPa.和42(10)%)。在ALM4+NO[26(10)kPaand 31(7)%；P<；0.00 1]的情况下，上述指标均有改善。ALM 16+NO使PaO2进一步提高至36(13)kPaP(P<；0.0001)，但分流无改善。平均肺动脉压在安慰剂组和ALM4+NO组相似[20(4)比23(5)mm Hg]，而在ALM 16+NO组增加到28(8)mm Hg(P<；0.01)。阿米替林和乳酸的血浆浓度在治疗过程中没有改变。小剂量阿米特林(4u g kg(-1)min(-1))联合吸入NO可显著改善开胸式OLV期间的氧合，而不改变肺血流动力学。在吸入NO的同时增加阿米特林的剂量(16微克·公斤·分~(-1)·分~(-1))，可进一步改善动脉血氧分压，但也会增加平均肺动脉压。
Background. Almitrine combined with inhaled nitric oxide (NO) can prevent hypoxia during one-lung ventilation (OLV). The optimal dose of almitrine that would provide therapeutic advantage with few side-effects during open-chest OLV has not been established.Methods. Forty-two patients undergoing thoracotomy were randomly allocated to three groups: placebo, almitrine 4 mu g kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM4+NO), and almitrine 16 mu g kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM 16+NO). Gas exchange, haemodynamic and respiratory variables and plasma concentrations of almitrine and lactate were monitored. Measurements were obtained with the patient awake (baseline), after induction of anaesthesia with two-lung ventilation (control 2LV), 20 min after treatment (2LV+T), and then at 10, 20 and 30 min of OLV (OLV10', OLV20' and OLV30') with Fi(O2)IResults. In the placebo group, OLV impaired Pa-O2, and increased pulmonary shunt [ 16 (SD 7) kPa. and 42 (10)% respectively]. These improved with ALM4+NO [26 (10) kPa and 31 (7)%; P < 0.00 1]. ALM 16+NO further improved Pa-O2 to36 (13) kPa(P < 0.0001) but gave no improvement in the shunt. Mean pulmonary artery pressure was similar in the placebo and ALM4+NO groups [20 (4) vs 23 (5) mm Hg], whereas it was increased in the ALM 16+NO group to 28 (8) mm Hg (P < 0.01). Plasma concentrations of almitrine and lactate were unaltered by the treatments.Conclusions. Low-dose almitrine (4 mu g kg(-1) min(-1)) together with inhaled NO significantly improves oxygenation during open-chest OLV, without modifying pulmonary haemodynamics. An increased dose of almitrine (16 mu g kg(-1) min(-1)) with inhaled NO further improves arterial oxygenation, but also increases mean pulmonary artery pressure.