Wysocki M, Delclaux C, Roupie E, Langeron O, Liu N, Herman B, Lemaire F, Brochard L
Service de Réanimation Polyvalente, Hôpital International de l'Université de Paris, France.
Intensive Care Med. 1994;20(4):254-9. doi: 10.1007/BF01708960.
To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange.
Prospective self-controlled study.
3 medico-surgical intensive care units.
17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88 +/- 30 mmHg, venous admixture: 47 +/- 7%) and elevated mean pulmonary artery pressure (MPAP: 30 +/- 5 mmHg) due to adult respiratory distress syndrome (ARDS).
5 conditions were studied: 1) baseline, 2) 5 to 10 ppm of NO during 30 min, 3) discontinuation of NO during 30 min, 4) ALM infusion (0.5 mg/kg) during 30 min, 5) ALM infusion (0.5 mg/kg) during 30 min in combination with 5 to 10 ppm of NO.
The PaO2/FIO2 ratio rose from 88 +/- 30 to 98 +/- 37 mmHg (NS) with NO alone, and from 92 +/- 25 to 130 +/- 56 mmHg (p < 0.01) with NO + ALM (p < 0.05 vs NO alone). Seven patients were considered as "NO-responders" (rise in PaO2/FIO2 ratio of 10 mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87 +/- 30 to 128 +/- 39 mmHg (p < 0.05) with NO alone, and from 93 +/- 20 to 169 +/- 51 mmHg (p < 0.01) with NO + ALM (p < 0.05 versus NO alone). MPAP decreased from 30 +/- 5 to 26 +/- 5 mmHg (p < 0.01) with NO alone, increased slightly from 28 +/- 5 to 31 +/- 5 mmHg (NS) with ALM alone and decreased to 27 +/- 5 mmHg (p < 0.05) with NO + ALM.
NO + ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.
评估吸入一氧化氮（NO）与静脉注射二甲磺酸烯丙哌三嗪（ALM）对气体交换的相加作用。
前瞻性自身对照研究。
3个内科-外科重症监护病房。
17例因成人呼吸窘迫综合征（ARDS）导致严重低氧血症（动脉血氧分压/吸入氧分数值[PaO2/FIO2]比值：88±30 mmHg，静脉血掺杂：47±7%）且平均肺动脉压（MPAP）升高（30±5 mmHg）的患者。
研究了5种情况：1）基线，2）30分钟内吸入5至10 ppm的NO，3）30分钟内停用NO，4）30分钟内静脉输注ALM（0.5 mg/kg），5）30分钟内静脉输注ALM（0.5 mg/kg）并同时吸入5至10 ppm的NO。
单独使用NO时，PaO2/FIO2比值从88±30 mmHg升至98±37 mmHg（无统计学意义）；NO + ALM联合使用时，该比值从92±25 mmHg升至130±56 mmHg（p < 0.01）（与单独使用NO相比，p < 0.05）。7例患者被视为“NO反应者”（单独使用NO时PaO2/FIO2比值升高10 mmHg或更多）；在该亚组中，单独使用NO时，PaO2/FIO2比值从87±30 mmHg升至128±39 mmHg（p < 0.05），NO + ALM联合使用时，该比值从93±2（此处可能有误，推测为93±20） mmHg升至169±51 mmHg（p < 0.01）（与单独使用NO相比，p < 0.05）。单独使用NO时，MPAP从30±5 mmHg降至26±5 mmHg（p < 0.01），单独使用ALM时，MPAP从28±5 mmHg略有升高至31±5 mmHg（无统计学意义），NO + ALM联合使用时，MPAP降至27±5 mmHg（p < 0.05）。
在ARDS患者中，NO + ALM对气体交换有相加作用，同时降低MPAP。单独使用NO的效果较小且无统计学意义，除了7例患者的亚组，在该亚组中两种治疗联合使用效果更显著。
