Farber M O, Daly R S, Strawbridge R A, Manfredi F
Chest. 1979 Apr;75(4):451-5. doi: 10.1378/chest.75.4.451.
This study investigated the effects of administration of methylprednisolone on oxygen transport in ten stable hypoxemic (mean arterial oxygen pressure, 54 +/- 3 mm Hg) patients with chronic obstructive pulmonary disease (COPD). At 24 hours (after four injections of a bolus of 30 mg of methylprednisolone sodium succinate per kilogram of body weight, given intravenously every six hours), significant differences (P less than 0.05) were an increased cardiac index (3.0 +/- 0.2 to 4.1 +/- 0.2 L/min/sq m), a decreased peripheral vascular resistance (1,186 +/- 100 to 849 +/- 60 dynes/sec/cm-5), an increased flow of oxygen to tissue (0.90 +/- 0.07 to 1.16 +/- 0.09 L/min), a decreased arteriovenous oxygen content difference (49 +/- 3 to 43 +/- 2 ml/L), a decreased concentration of hydrogen ions in the arterial blood (38 +/- 1 to 35 +/- 1 nmol/L) and arterial carbon dioxide tension (39 +/- 2 to 32 +/- 1 mm Hg), and increased levels of lactate (1.1 +/- 0.2 to 3.7 +/- 1.0 mmol/L) and pyruvate (0.14 +/- 0.04 to 0.37 +/- 0.08 mmol/L). Fractional oxygen utilization, oxygen consumption, the partial pressure of oxygen at which hemoglobin was 50 percent saturated, and the level of 2,3-diphosphoglyceric acid remained unchanged. In vitro studies showed that these patients' red blood cells responded with a significant (more than 35 percent) increase in the level of 2.3-diphosphoglyceric acid when incubated for ten hours with concentrations of methylprednisolone that were much higher (1.0 mg/ml) than those attained in vivo (12.5 microgram/ml). These studies demonstrate that repeated infusions of high doses of steroids in a bolus in stable hypoxemic patients with COPD produce significant physiologic changes but no apparent net gain in the oxygenation of tissues.
本研究调查了甲泼尼龙给药对10例稳定型低氧血症（平均动脉血氧分压，54±3 mmHg）慢性阻塞性肺疾病（COPD）患者氧转运的影响。在24小时时（每6小时静脉注射一次每千克体重30 mg甲泼尼龙琥珀酸钠，共注射4次后），出现了显著差异（P<0.05）：心脏指数增加（从3.0±0.2升至4.1±0.2 L/min/m²），外周血管阻力降低（从1186±100降至849±60达因·秒/厘米⁻⁵），组织氧流量增加（从0.90±0.07升至1.16±0.09 L/min），动静脉血氧含量差降低（从49±3降至43±2 ml/L），动脉血中氢离子浓度降低（从38±1降至35±1 nmol/L）以及动脉二氧化碳分压降低（从39±2降至32±1 mmHg），乳酸水平升高（从1.1±0.2升至3.7±1.0 mmol/L）和丙酮酸水平升高（从0.14±0.04升至0.37±0.08 mmol/L）。氧利用率、氧耗量、血红蛋白饱和度为50%时的氧分压以及2,3 - 二磷酸甘油酸水平保持不变。体外研究表明，这些患者的红细胞在与浓度远高于体内达到的浓度（1.0 mg/ml，而体内为12.5 μg/ml）的甲泼尼龙孵育10小时后，2,3 - 二磷酸甘油酸水平显著升高（超过35%）。这些研究表明，对稳定型低氧血症的COPD患者大剂量推注重复输注类固醇会产生显著的生理变化，但组织氧合无明显净获益。
