Díaz-Regañón Valverde G, Fernández Rico R, Iribarren Sarrías J L, López Sánchez M, Iglesias Fraile L, Ibáñez Elejalde E, Rodríguez Borregán J C, González Herrera S, Garrido Díaz C, López Espadas F
Unidad de Politraumatizados, Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander.
Rev Esp Anestesiol Reanim. 2000 Feb;47(2):57-62.
To compare the effects of 5 and 20 ppm of nitric oxide, evaluating time until response for each dose, in patients with adult respiratory distress syndrome (ARDS).
The study was prospective, controlled and random. Fifteen patients assigned to two groups received either 5 ppm (8 patients) or 20 ppm (7 patients) from November 96 to July 97. The main variables analyzed were PaO2/FiO2 and pulmonary vascular resistance index. We also studied etiology, severity of pulmonary damage as reflected by the Lung Injury Score, age, sex, Apache II prognostic score and exitus. Outcome was considered good if PaO2/FiO2 increased and/or pulmonary vascular resistance index decreased by more than 30% from the initial level (before inhalation of nitric oxide).
The mean lung injury score was 2.9 +/- 0.4 and the two groups were homogeneous. Time until response to nitric oxide was significantly less in the 20 ppm group. Both PaO2/FiO2 and pulmonary vascular resistance index improved significantly in both groups whereas Qs/Qt improved only in the 20 ppm group. We also found that cardiac index and oxygen transport increased, the latter significantly only in the 20 ppm group. NO2 formation was less than 2 ppm and methemoglobin levels did not rise above 2%.
Inhaled nitric oxide significantly improves oxygenation and decreases pulmonary vascular resistance without altering systemic vascular resistance during treatment of ARDS. The final outcomes were similar for both doses, but the 20 ppm dose produced a significantly faster response as well as a significant decrease in Qs/Qt.
比较5 ppm和20 ppm一氧化氮对成人呼吸窘迫综合征（ARDS）患者的影响，评估各剂量起效时间。
本研究为前瞻性、对照性和随机性研究。1996年11月至1997年7月，15例患者被分为两组，分别吸入5 ppm（8例患者）或20 ppm（7例患者）一氧化氮。分析的主要变量为动脉血氧分压/吸入氧分数值（PaO2/FiO2）和肺血管阻力指数。我们还研究了病因、肺损伤评分所反映的肺损伤严重程度、年龄、性别、急性生理与慢性健康状况评分系统II（Apache II）预后评分以及死亡情况。如果PaO2/FiO2升高和/或肺血管阻力指数较初始水平（吸入一氧化氮前）降低超过30%，则认为预后良好。
平均肺损伤评分为2.9±0.4，两组具有同质性。20 ppm组对一氧化氮的反应时间明显更短。两组的PaO2/FiO2和肺血管阻力指数均显著改善，而分流率（Qs/Qt）仅在20 ppm组有所改善。我们还发现心指数和氧输送增加，后者仅在20 ppm组显著增加。二氧化氮生成量小于2 ppm，高铁血红蛋白水平未升至2%以上。
在ARDS治疗过程中，吸入一氧化氮可显著改善氧合并降低肺血管阻力，而不改变体循环血管阻力。两种剂量的最终结果相似，但20 ppm剂量起效明显更快，且Qs/Qt显著降低。
