Draxler V, Krenn J, Mauritz W, Sporn P
Anaesthesist. 1980 Nov;29(11):597-601.
The effects of intravenous isosorbide dinitrate (ISDN: 3, 6, 9, and 12 mg/h) on systemic and pulmonary vasculature, gas exchange, and dynamic lung compliance were investigated in 7 controlled ventilated patients suffering from ARDS after trauma or in sepsis. Parameters were recorded before and after 20 min. ISDN infusion with 30 min interruption between the different dosage steps. Systemic circulation, heart rate, cardiac index, and stroke index remained grossly unchanged. MPAP was significantly decreased at 6, 9, and 12 mg/h ISDN to 61,7%, 61%, and 69,3% of initial value, as well as PCWP to 49,6% 45,5% and 41,5% of initial value. The drop of RVSWI at 6 and 9 mg/h ISDN to 59,1% and 63,2% also was statistically significant. There was an increase in Qs/Qt, AaDO2, and dynClung, though the increases were not statistically significant. O2availability remained unchanged. Administration of ISDN in ARDS causes an improvement in right ventricular function due to a reduction of pre- and afterload as well as intrapulmonary blood volume. In a similar manner increasing lung compliance may be explained by volume shif. The slight alterations of ventilation-perfusion-ratio as seen by increases in Qs/Qt and AaDO2 can be tolerated because of the unchanged O2availability.
研究了静脉输注硝酸异山梨酯（ISDN：3、6、9和12mg/h）对7例创伤后或脓毒症所致急性呼吸窘迫综合征（ARDS）且接受控制通气患者的体循环和肺循环、气体交换及动态肺顺应性的影响。在不同剂量阶段之间中断输注30分钟，输注20分钟前后记录各项参数。体循环、心率、心脏指数和每搏指数总体保持不变。ISDN剂量为6、9和12mg/h时，平均肺动脉压（MPAP）显著降低至初始值的61.7%、61%和69.3%，肺毛细血管楔压（PCWP）降至初始值的49.6%、45.5%和41.5%。ISDN剂量为6和9mg/h时，右心室每搏功指数（RVSWI）降至59.1%和63.2%，差异也有统计学意义。分流率（Qs/Qt）、肺泡-动脉血氧分压差（AaDO2）和动态肺顺应性（dynClung）有所增加，尽管增加无统计学意义。氧输送保持不变。ARDS患者应用ISDN可通过降低前负荷、后负荷及肺内血容量来改善右心室功能。以类似方式，肺顺应性增加可通过容量转移来解释。由于氧输送未变，Qs/Qt和AaDO2增加所显示的通气/血流比值的轻微改变可被耐受。
