Ricou B, Grandin S, Jolliet P, Chevrolet J C, Suter P M
Département d'anesthésiologie, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1994 Apr 9;124(14):583-8.
Inhaled nitric oxide (NO) may be beneficial in patients with adult respiratory distress syndrome (ARDS), by lowering the venous admixture in the lungs and thereby improving the hypoxemia, and by its vasodilator effect which improves pulmonary hypertension. We studied 6 patients with severe ARDS (PaO2/FiO2 9.6 +/- 1.7 kPa and mean pulmonary artery pressure [PAPm] 37 +/- 4 mm Hg) during short term inhalation of NO (30 minutes) at a concentration of 32 ppm. In all patients, we observed the same response, i.e. a significant increase in PaO2 (28 +/- 8% at the same FiO2, p = 0.014) and a decrease in PAPm (15 +/- 5%; p = 0.038) with rapid reversal when NO inhalation was halted. Toxic metabolites of NO, such as NO2, NO3, etc. remained < 1 ppm when measured in different sections of the respiratory circuit. We conclude, in agreement with the study of Rossaint et al. [16], that (1.) inhaled NO may be beneficial in ARDS by improving pulmonary hypertension and gas exchange; (2.) short term NO inhalation is probably safe; (3.) however, the safety of long term administration of NO and a beneficial effect on survival in ARDS patients remain to be shown.
吸入一氧化氮（NO）可能对成人呼吸窘迫综合征（ARDS）患者有益，它可降低肺部静脉血掺杂，从而改善低氧血症，还可通过其血管舒张作用改善肺动脉高压。我们对6例重度ARDS患者（动脉血氧分压/吸入氧分数值[PaO2/FiO2]为9.6±1.7 kPa，平均肺动脉压[PAPm]为37±4 mmHg）进行了研究，让他们短期（30分钟）吸入浓度为32 ppm的NO。在所有患者中，我们观察到了相同的反应，即在相同的FiO2下，PaO2显著升高（28±8%，p = 0.014），PAPm降低（15±5%；p = 0.038），停止吸入NO后反应迅速逆转。在呼吸回路的不同部位进行测量时，NO的毒性代谢产物如NO2、NO3等仍<1 ppm。我们与罗桑特等人[16]的研究结果一致，得出以下结论：（1.）吸入NO可能通过改善肺动脉高压和气体交换对ARDS有益；（2.）短期吸入NO可能是安全的；（3.）然而，NO长期给药的安全性以及对ARDS患者生存率的有益影响仍有待证实。
