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临床试验
． 1997年5月,25(5):786 - 94。
doi: 10.1097 / 00003246-199705000-00013。

俯卧位、一氧化氮和二甲基亚硝胺对急性呼吸窘迫综合征气体交换和氧气运输的附加有益影响

P Jolliet1， P Bulpa， 米丽兹， B Ricou， J·洛佩兹， J C雪佛兰
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临床试验

俯卧位、一氧化氮和二甲基亚硝胺对急性呼吸窘迫综合征气体交换和氧气运输的附加有益影响

P Jollietet al。 暴击治疗地中海． 1997年5月．

摘要

摘要目的:为了验证俯卧位通气的假设，一氧化氮和双甲磺酸阿mitrine通过不同的机制改善动脉氧合，联合应用于严重急性呼吸窘迫综合征(ARDS)患者可发挥附加的有益作用。

设计:前瞻性，非随机，介入研究。

设置:在一个大学三级护理中心的内科和外科重症监护室。

病人:12例急性呼吸窘迫综合征及严重低氧血症患者，肺动脉闭塞压< 18mmhg, PaO2/FIO2 <或= 150,FIO2 >或= 0.6。

干预措施:仰卧位和俯卧位吸入一氧化氮(百万分之20持续15分钟)，俯卧位时静脉注射双甲磺酸阿米特林(1mg /kg/hr持续60分钟)，单独或与一氧化氮联合使用。

测量及主要结果:在顺序的时间点进行血流动力学、血气和气体交换测量:a)基线仰卧位;B)仰卧位一氧化氮;C)恢复基线仰卧位后;D)俯卧30分钟后;E)俯卧120分钟后;F)一氧化氮易产生;G)恢复基线俯卧撑后;H) almitrine双甲磺酸易感性;i)一氧化氮和双甲磺酸阿米特林联合作用15分钟。如果观察到PaO2增加>或= 10 torr(>或= 1.3 kPa)或PaO2/FIO2比值增加>或= 20，则认为患者对俯卧位有反应。 Seven patients (58%) responded to being turned prone. Compared with supine baseline conditions, nitric oxide and supine position increased arterial oxygen saturation from 89 +/- 1 (SD)% to 92 +/- 3% (p < .05) and nitric oxide plus prone position increased arterial oxygen saturation (94 +/- 3% vs. 89 +/- 4%, p < .05) and decreased the alveolar-arterial oxygen difference from 406 +/- 124 torr (54 +/- 15 kPa) to 387 +/- 108 torr (51 +/- 14 kPa) (p < .05). Almitrine bismesylate increased PaO2/FIO2 vs. baseline (122 +/- 58 vs. 84 +/- 21, p < .05). Almitrine bismesylate decreased the alveolar-arterial oxygen difference vs. baseline from 406 +/- 124 torr (53.9 +/- 16.5 kPa) to 386 +/- 112 torr (51.3 +/- 14.8 kPa) and vs. nitric oxide and supine position from 406 +/- 111 torr (53.9 +/- 14.7 kPa) to 386 +/- 112 torr (51.3 +/- 14.8 kPa) (p < .05). Prone position alone did not improve oxygenation. However, the combination of nitric oxide and almitrine bismesylate increased PaO2/FIO2 vs. nitric oxide supine and nitric oxide prone conditions (147 +/- 69 vs. 84 +/- 25 and 91 +/- 18, respectively; p < .05). In patients responding to the prone position (n = 7), combining nitric oxide and almitrine bismesylate led to further improvement in PaO2 compared with the prone position alone, with PaO2 increasing from 78 +/- 12 torr (10.3 +/- 1.6 kPa) to 111 +/- 55 torr (14.7 +/- 7.3 kPa) (p < .05), which was not the case when either nitric oxide or almitrine bismesylate was added separately. Heart rate and cardiac output were increased by almitrine bismesylate compared with all other measurements. Mean pulmonary arterial pressure was decreased by nitric oxide (27 +/- 7 vs. 30 +/- 7 mm Hg nitric oxide supine vs. baseline supine and 29 +/- 7 vs. 33 +/- 8 mm Hg nitric oxide prone vs. baseline prone, p < .05) and increased by almitrine bismesylate (36 +/- 9 vs. 30 +/- 7 mm Hg baseline supine, 27 +/- 7 mm Hg nitric oxide supine, 33 +/- 8 mm Hg baseline prone, and 29 +/- 7 mm Hg nitric oxide prone; p < .05). The increase in mean pulmonary arterial pressure was totally abolished by nitric oxide (31 +/- 5 vs. 36 +/- 9 mm Hg, p < .05). Minute ventilation, respiratory system compliance, physiologic deadspace, and PaCO2 remained unchanged.

结论:对于严重低氧血症的ARDS患者，俯卧位、一氧化氮、双甲磺酸阿米特林联合使用可改善动脉氧合，无不良影响。

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