Walmrath D, Schneider T, Schermuly R, Olschewski H, Grimminger F, Seeger W
Department of Internal Medicine, Justus-Liebig University, Giessen, Germany.
Am J Respir Crit Care Med. 1996 Mar;153(3):991-6. doi: 10.1164/ajrccm.153.3.8630585.
Inhalation of NO and aerosolization of PGI2 have been suggested to achieve selective pulmonary vasodilation and improvement of arterial oxygenation in patients with ARDS. We directly compared these two modes of transbronchial vasodilator therapy in 16 ARDS patients mechanically ventilated (mean lung injury score [1] 2.75 +/- 0.05). Patients were randomized to receive either first NO and then PGI2, or vice versa. Each drug was individually titrated to find the maximum improvement of arterial oxygenation. Gas exchange variables, including data from the multiple inert gas elimination technique (MIGET), and hemodynamics under application of NO/PGI2 were compared with pre- and post-challenge values. NO (17.8 +/- 2.7 ppm) increased Pa O2/FI O2 from 115 +/- 12 to 144 +/- 15 mm Hg (p<0.01) and reduced the shunt-flow from 33.1 +/- 3.6 to 26.6 +/- 4.5% (p<0.05). Aerosolized PGI2 (7.5 +/- 2.5 ng/kg min) augmented Pa O2/FI O2 from 114 +/- 12 to 135 +/- 12 mm Hg (p<0.01), and decreased shunt from 33.5 +/- 3.8 to 26.0 +/- 3.9% (p<0.05). In 10 patients, both NO and PGI2 caused an increase in Pa O2/FI O2 by at least 10 mm Hg. Two further patients displayed an improvement of arterial oxygenation in response to either NO or PGI2. NO decreased mean pulmonary artery pressure from 34.8 +/- 2.2 to 33.0 +/- 1.8 mm Hg, and PGI2 from 35.0 +/- 2.2 to 31.9 +/- 1.7 mm Hg (p<0.05). We conclude that individually titrated doses of inhaled NO and aerosolized PGI2 effect selective pulmonary vasodilation and redistribute blood-flow from shunt-areas to well-ventilated regions with nearly identical efficacy profiles.
吸入一氧化氮（NO）和气雾化前列环素（PGI2）被认为可实现选择性肺血管舒张，并改善急性呼吸窘迫综合征（ARDS）患者的动脉氧合。我们在16例接受机械通气的ARDS患者（平均肺损伤评分[1]2.75±0.05）中直接比较了这两种经支气管血管舒张剂治疗方式。患者被随机分为先接受NO然后接受PGI2，或反之。每种药物分别进行滴定以找到动脉氧合的最大改善。将包括来自多种惰性气体消除技术（MIGET）的数据在内的气体交换变量以及应用NO/PGI2时的血流动力学与激发前后的值进行比较。NO（17.8±2.7 ppm）使动脉血氧分压/吸入氧分数（Pa O2/FI O2）从115±12升高至144±15 mmHg（p<0.01），并使分流率从33.1±3.6%降至26.6±4.5%（p<0.05）。雾化PGI2（7.5±2.5 ng/kg·min）使Pa O2/FI O2从114±12升高至135±12 mmHg（p<0.01），并使分流率从33.5±3.8%降至26.0±3.9%（p<0.05）。在10例患者中，NO和PGI2均使Pa O2/FI O2升高至少10 mmHg。另外2例患者对NO或PGI2有动脉氧合改善。NO使平均肺动脉压从34.8±2.2降至33.0±1.8 mmHg，PGI2从35.0±2.2降至31.9±1.7 mmHg（p<0.05）。我们得出结论，个体化滴定剂量的吸入NO和气雾化PGI2可实现选择性肺血管舒张，并将血流从分流区域重新分布到通气良好的区域，且疗效几乎相同。
