Silverman H J, Slotman G, Bone R C, Maunder R, Hyers T M, Kerstein M D, Ursprung J J
University of Maryland Hospital, Baltimore 21201.
Chest. 1990 Aug;98(2):405-10. doi: 10.1378/chest.98.2.405.
We wanted to determine the long-term effects of a continuous infusion of PGE1 on DO2 and VO2 in patients with ARDS. Data were obtained from a randomized double-blind multicenter trial, which evaluated the effects of PGE1 on survival in patients with ARDS. Patients were stratified according to treatment and outcome: placebo-died (n = 8); PGE1-died (n = 12); placebo-survived (n = 9); and PGE1-survived (n = 8). In the placebo-died group, elevations occurred in VO2, which were associated with increases in O2ext and a constant DO2. In contrast, in the PGE1-died group, elevations in VO2 were associated with increases in DO2 and an unchanged O2ext. In the placebo-survived group, VO2 and DO2 decreased, whereas in the PGE1-survived group, VO2 and DO2 increased; however, O2ext decreased in both of these groups. Since impaired O2ext occurs in ARDS, PGE1-induced elevations in DO2, rather than compensatory increases in O2ext, may achieve better tissue oxygenation. We conclude that although the recently completed multicenter trial failed to show an enhancing effect of PGE1 on survival in patients with advanced ARDS, PGE1 may have important effects on oxygen transport and, therefore, may still have a role in the treatment of early manifestations of ARDS, either alone or in combination with other agents.
我们想要确定持续输注前列腺素E1（PGE1）对急性呼吸窘迫综合征（ARDS）患者氧输送（DO2）和氧耗（VO2）的长期影响。数据来自一项随机双盲多中心试验，该试验评估了PGE1对ARDS患者生存率的影响。患者根据治疗情况和预后进行分层：安慰剂组死亡（n = 8）；PGE1组死亡（n = 12）；安慰剂组存活（n = 9）；PGE1组存活（n = 8）。在安慰剂组死亡患者中，VO2升高，这与氧摄取率（O2ext）增加和DO2恒定有关。相比之下，在PGE1组死亡患者中，VO2升高与DO2增加和O2ext不变有关。在安慰剂组存活患者中，VO2和DO2降低，而在PGE1组存活患者中，VO2和DO2升高；然而，这两组患者的O2ext均降低。由于ARDS患者存在O2ext受损的情况，PGE1诱导的DO2升高，而非O2ext的代偿性增加，可能实现更好的组织氧合。我们得出结论，尽管最近完成的多中心试验未能显示PGE1对晚期ARDS患者生存率有增强作用，但PGE1可能对氧转运有重要影响，因此，其在单独或与其他药物联合治疗ARDS早期表现时可能仍发挥作用。
