Rialp G, Betbesé A J, Pérez-Márquez M, Mancebo J
Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Av. SAM Claret 167, 08025 Barcelona, Spain.
Am J Respir Crit Care Med. 2001 Jul 15;164(2):243-9. doi: 10.1164/ajrccm.164.2.2002087.
Inhaled nitric oxide (NO) and prone position (PP) are frequently used in the treatment of acute respiratory distress syndrome (ARDS). We compared the gas exchange and hemodynamic effects induced by the combination of NO inhalation and PP in patients with ARDS and analyzed whether or not pulmonary (Pu) and extrapulmonary (Epu) ARDS patients behave differently. Eight Pu and seven Epu ARDS patients were studied in four situations: supine position (SP); SP with NO inhalation at 5 ppm (SP + NO); PP; and PP with NO inhalation (PP + NO). In comparison with SP, NO inhalation and PP induced significant increases in Pa(O(2))/FI(O(2)) (from 106 +/- 58 in SP to 131 +/- 69 mm Hg in SP + NO, p = 0.01, and to 184 +/- 67 mm Hg in PP, p < 0.001). Pu and Epu ARDS showed a similar improvement in Pa(O(2))/FI(O2) with PP. Only Pu ARDS patients showed a significant increase (p < 0.001) in oxygenation induced by NO inhalation from 81 +/- 45 to 100 +/- 50 mm Hg in SP, and from 146 +/- 53 to 197 +/- 98 mm Hg in PP. In conclusion, PP is associated with a marked improvement in oxygenation, irrespective of the causes of ARDS, and additive effects of NO inhalation are mainly seen in patients with Pu ARDS.
吸入一氧化氮（NO）和俯卧位（PP）常用于治疗急性呼吸窘迫综合征（ARDS）。我们比较了ARDS患者吸入NO与PP联合应用时的气体交换和血流动力学效应，并分析了肺内型（Pu）和肺外型（Epu）ARDS患者的表现是否不同。对8例Pu ARDS患者和7例Epu ARDS患者在四种情况下进行了研究：仰卧位（SP）；吸入5 ppm NO的SP（SP + NO）；PP；以及吸入NO的PP（PP + NO）。与SP相比，吸入NO和PP使Pa(O₂)/FI(O₂)显著升高（从SP时的106±58 mmHg升高至SP + NO时的131±69 mmHg，p = 0.01，PP时升高至184±67 mmHg，p < 0.001）。Pu和Epu ARDS患者在PP时Pa(O₂)/FI(O₂)均有类似改善。仅Pu ARDS患者吸入NO可使氧合显著增加（p < 0.001），在SP时从81±45 mmHg升高至100±50 mmHg，在PP时从146±53 mmHg升高至197±98 mmHg。总之，无论ARDS病因如何，PP均与氧合显著改善相关，且吸入NO的附加效应主要见于Pu ARDS患者。
