Andrivet P, Chabrier P E, Defouilloy C, Brun-Buisson C, Adnot S
Laboratoire d'Explorations Fonctionnelles, Hôpital Henri Mondor, Creteil, France.
Chest. 1994 Jul;106(1):118-24. doi: 10.1378/chest.106.1.118.
The potent pulmonary vasodilating property of atrial natriuretic factor (ANF) may alter gas exchange in patients with COPD. We examined the hemodynamic and gas exchange responses to intravenous infusion of ANF (0.01 and 0.03 ng/min/kg body weight) in eight stable patients with COPD studied during spontaneous breathing, using the inert gas elimination technique. When compared with baseline, ANF infusion was associated with a dose-dependent decrease in pulmonary artery pressure (from 27.3 +/- 2.5 to 23.9 +/- 1.8 and 20.2 +/- 1.7 mm Hg, respectively) and a dose-dependent increase in blood flow perfusing poorly ventilated and unventilated units (VA/Q < 0.1: from 5.80 +/- 2.05 to 7.25 +/- 2.5 and 12.0 +/- 5.4 percent of total blood flow, respectively; p = 0.02). However, PaO2 remained unchanged (70.2 +/- 3.6, 68.1 +/- 3.8 65.4 +/- 3.5 mm Hg, respectively) because of a significant increase in minute ventilation (VE) from 8.6 +/- 0.8 to 9.6 +/- 0.8 and 10.3 +/- 0.7 L/min (p < 0.002). Six additional COPD patients receiving intravenously administered ANF at the same dosages were studied during controlled mechanical ventilation using right heart catheterization. In these patients, pulmonary vasodilation was associated with a significant increase in venous admixture (from 12.7 +/- 2.4 to 14.4 +/- 2.9 and 17.5 +/- 3.5 percent of total blood flow, respectively; p < 0.02), and a dose-dependent reduction in arterial PO2 (from 117 +/- 17 to 110 +/- 15 and 96.4 +/- 8.8 mm Hg, respectively; p < 0.05). The present results show that ANF infusion is associated with alterations in the VA/Q relationship in patients with COPD. However, a decrease in arterial oxygenation may be prevented by an increase in VE.
心房利钠因子（ANF）强大的肺血管舒张特性可能会改变慢性阻塞性肺疾病（COPD）患者的气体交换。我们使用惰性气体清除技术，对8例稳定期COPD患者在自主呼吸时静脉输注ANF（0.01和0.03 ng/min/kg体重）后的血流动力学和气体交换反应进行了研究。与基线相比，输注ANF导致肺动脉压呈剂量依赖性降低（分别从27.3±2.5降至23.9±1.8和20.2±1.7 mmHg），灌注通气不良和未通气肺单位的血流量呈剂量依赖性增加（VA/Q<0.1：分别从占总血流量的5.80±2.05%增至7.25±2.5%和12.0±5.4%；p = 0.02）。然而，由于分钟通气量（VE）从8.6±0.8显著增加至9.6±0.8和10.3±0.7 L/min（p<0.0)，动脉血氧分压（PaO2）保持不变（分别为70.2±3.6、68.1±3.8、65.4±3.5 mmHg）。另外6例接受相同剂量静脉注射ANF的COPD患者在控制机械通气时，使用右心导管进行了研究。在这些患者中，肺血管舒张与静脉血掺杂显著增加相关（分别从占总血流量的12.7±2.4%增至14.4±2.9%和17.5±3.5%；p<0.02），且动脉血氧分压呈剂量依赖性降低（分别从117±17降至110±15和96.4±8.8 mmHg；)<0.05）。目前的结果表明，输注ANF与COPD患者的VA/Q关系改变有关。然而，VE增加可预防动脉氧合降低。
