Tatsumi K, Kimura H, Kunitomo F, Okita S, Tojima H, Yuguchi Y, Kuriyama T, Watanabe S, Honda Y
Am Rev Respir Dis. 1986 Apr;133(4):552-7. doi: 10.1164/arrd.1986.133.4.552.
Twelve patients with chronic obstructive pulmonary disease (COPD) were studied to determine the effect of ventilatory stimulation with chlormadinone acetate (CMA), a potent synthetic progesterone, on chemical and neuromechanical respiratory controls and pulmonary gas exchange. Using a randomized, double-blind, cross-over trial, 1 wk of CMA therapy caused a significant reduction in arterial CO2 tension (Paco2) by 4.6 +/- 0.6 (SE) mmHg. This Paco2 fall was associated with increased minute ventilation (Vl), tidal volume (VT), and mean inspiratory flow (VT/Tl). During CMA administration, occlusion pressure response to CO2 with and without inspiratory flow-resistive loading increased significantly (p less than 0.01) over that during placebo administration, whereas ventilatory response to CO2 did not. In addition, normocapnic ventilatory and occlusion pressure response to hypoxia were significantly elevated (p less than 0.01) during CMA therapy. Furthermore, the degree of load compensation, which was assessed by the ratio of the loaded to unloaded slope in the occlusion pressure response to CO2, increased in all subjects after CMA administration. These results indicate that CMA augments not only the respiratory neuromuscular response to hypercapnia and hypoxia, but also flow-resistive load compensation in patients with COPD, and it may provide support for the use of CMA in patients who are able to decrease their Paco2 with this agent.
对12例慢性阻塞性肺疾病（COPD）患者进行了研究，以确定强效合成孕激素醋酸氯地孕酮（CMA）的通气刺激对化学性和神经机械性呼吸控制以及肺气体交换的影响。采用随机、双盲、交叉试验，1周的CMA治疗使动脉血二氧化碳分压（Paco2）显著降低4.6±0.6（标准误）mmHg。Paco2的下降与分钟通气量（Vl）、潮气量（VT）和平均吸气流量（VT/Tl）增加有关。在给予CMA期间，无论有无吸气流量阻力负荷时对二氧化碳的阻断压反应均比给予安慰剂期间显著增加（p<0.01），而对二氧化碳的通气反应则无变化。此外，在CMA治疗期间，对低氧的正常碳酸血症通气和阻断压反应显著升高（p<0.01）。而且，通过二氧化碳阻断压反应中负荷与无负荷斜率之比评估的负荷补偿程度在给予CMA后所有受试者中均增加。这些结果表明，CMA不仅增强了COPD患者对高碳酸血症和低氧的呼吸神经肌肉反应，还增强了流量阻力负荷补偿，并且它可能为能够使用该药物降低Paco2的患者使用CMA提供支持。
