Kondo Cláudia Seiko, Macchionne Mariângela, Nakagawa Naomi Kondo, de Carvalho Carlos Roberto Ribeiro, King Malcolm, Saldiva Paulo Hilário Nascimento, Lorenzi-Filho Geraldo
Universidade de São Paulo, São Paulo, Brazil.
Crit Care. 2002 Feb;6(1):81-7. doi: 10.1186/cc1458. Epub 2001 Nov 19.
The use of intravenous (IV) furosemide is common practice in patients under mechanical ventilation (MV), but its effects on respiratory mucus are largely unknown. Furosemide can affect respiratory mucus either directly through inhibition of the NaK(Cl)2 co-transporter on the basolateral surface of airway epithelium or indirectly through increased diuresis and dehydration. We investigated the physical properties and transportability of respiratory mucus obtained from 26 patients under MV distributed in two groups, furosemide (n = 12) and control (n = 14). Mucus collection was done at 0, 1, 2, 3 and 4 hours. The rheological properties of mucus were studied with a microrheometer, and in vitro mucociliary transport (MCT) (frog palate), contact angle (CA) and cough clearance (CC) (simulated cough machine) were measured. After the administration of furosemide, MCT decreased by 17 +/- 19%, 24 +/- 11%, 18 +/- 16% and 18 +/- 13% at 1, 2, 3 and 4 hours respectively, P < 0.001 compared with control. In contrast, no significant changes were observed in the control group. The remaining parameters did not change significantly in either group. Our results support the hypothesis that IV furosemide might acutely impair MCT in patients under MV.
在接受机械通气（MV）的患者中，静脉注射（IV）呋塞米是常用的治疗方法，但其对呼吸道黏液的影响尚不清楚。呋塞米可能通过抑制气道上皮细胞基底外侧表面的NaK(Cl)2共转运体直接影响呼吸道黏液，也可能通过增加利尿和脱水间接影响。我们调查了26例接受MV的患者的呼吸道黏液的物理性质和可运输性，这些患者分为两组，即呋塞米组（n = 12）和对照组（n = 14）。在0、1、2、3和4小时收集黏液。用微流变仪研究黏液的流变学性质，并测量体外黏液纤毛转运（MCT）（蛙腭）、接触角（CA）和咳嗽清除率（CC）（模拟咳嗽机）。给予呋塞米后，MCT在1、2、3和4小时分别下降了17±19%、24±11%、18±16%和18±13%，与对照组相比，P < 0.001。相比之下，对照组未观察到显著变化。两组的其余参数均未发生显著变化。我们的结果支持以下假设：静脉注射呋塞米可能会急性损害接受MV的患者的MCT。
