Powers S R, Shah D, Ryon D, Newell J, Ralph C, Scovill W, Dutton R
Ann Surg. 1977 Jun;185(6):619-25. doi: 10.1097/00000658-197706000-00002.
Increased pulmonary artery pressure, an increase in pulmonary vascular resistance and an increase in physiologic dead space are consistent findings in patients with post-traumatic respiratory distress. Since mannitol has been shown to decrease renal vascular resistance following trauma, the effect of a bolus injection of 100 ml of 25% solution of this drug on pulmonary hemodynamics and physiologic dead space was investigated in 11 patients who had suffered multiple trauma. Five minutes after the injection, pulmonary vascular resistance fell (p less than .01), cardiac index increased (p less than .001) and physiologic dead space decreased (p less than .05). In contrast, the administration of 40 mg of furosemide produced no significant change in any of these parameters. Mannitol rapidly equilibrates in the extracellular space and exerts an osmotic effect across cell membranes. We postulate that the beneficial response to mannitol on the pulmonary vascular resistance and the improved perfusion of ventilated regions of the lung is due to a reduction in cell swelling and is not explainable by its diuretic effect. Improvement in the distribution of perfusion of pulmonary blood flow by mannitol may be a useful aid in the treatment of the post-traumatic form of the respiratory distress syndrome.
肺动脉压升高、肺血管阻力增加以及生理死腔增加是创伤后呼吸窘迫患者的常见表现。由于甘露醇已被证明可降低创伤后的肾血管阻力，因此在11例多发伤患者中研究了静脉推注100 ml 25%该药物溶液对肺血流动力学和生理死腔的影响。注射后5分钟，肺血管阻力下降（p<0.01），心脏指数增加（p<0.001），生理死腔减少（p<0.05）。相比之下，给予40 mg呋塞米对这些参数均无显著影响。甘露醇在细胞外液中迅速达到平衡，并在细胞膜上发挥渗透作用。我们推测，甘露醇对肺血管阻力的有益作用以及肺通气区域灌注的改善是由于细胞肿胀减轻，而非其利尿作用所致。甘露醇改善肺血流灌注分布可能有助于治疗创伤后形式的呼吸窘迫综合征。
