摘要
对 18例慢性阻塞性肺疾病继发肺动脉高压患者行右心漂浮导管术 ,观察吸入 40ppm一氧化氮对患者血流动力学、血气、肺内气体交换、高铁血红蛋白的影响及其与血浆环磷酸鸟苷变化的关系。结果发现 ,吸入一氧化氮 2、8、15min时 ,肺血管阻力分别下降了 2 8.1%、31.3%及 34.4% ,平均肺动脉压也相应降低 (P均 <0 .0 1)。停止吸入一氧化氮后 2min ,肺血管阻力和平均肺动脉压又恢复至吸入前水平。但吸入一氧化氮对体动脉压、体血管阻力无明显影响。吸入一氧化氮 15min时 ,氧分压由 6 .9± 1.5kPa升至 7.8± 1.9kPa ,肺内分流由 2 6 %± 6 %降至2 0 %± 7% ,混合静脉血浆环磷酸鸟苷浓度由 14.6± 7.8pmol/L升至 2 8.9± 6 .7pmol/L(P均 <0 .0 5 ) ,但吸入一氧化氮对二氧化碳分压、氧运输、氧摄取率、高铁血红蛋白含量等无明显影响 (P >0 .0 5 )。结果提示 ,吸入一氧化氮可选择性降低慢性阻塞性肺疾病继发肺动脉高压患者肺动脉压 ,降低肺内分流 ,增加氧分压 ,其机理可能与环磷酸鸟苷增加有关。
Aim To study the effects and mechanism aroused from inhalation of nitric oxide (NO) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). Methods The pulmonary and systemic hemodynamics, blood gas exchange, oxygen transportation, guanosine 3', 5'-cyclic monophosphate (cGMP), and methemoglobin (MetHb) level were measured with Swan-Ganz catheter in 18 patients with COPD-PH before and after inhalation of 40 ppm NO. Results The pulmonary vascular resistance (PVR) was decreased by 28.1%, 31.3% and 34.4%, respectively, meanwhile the mean pulmonary arterial pressure (mPAP) was also decreased after continuous inhalation of NO for 2 min, 8 min and 15 min (P<0.01). Both mPAP and PVR were returned to basic line in 2 min after a stop of inhaled NO. Moreover, few effects of inhaled NO on systemic arterial pressure and systemic vascular resistance was observed. After inhaled NO 15 min, PaO 2 was increased from 6.9±1.5 kPa to 7.8±1.9 kPa, Qs/Qt was decreased from 26%±6% to 20%±7% , and mixed venous cGMP level was increased from 14.6±7.8 pmol/L to 28.9±6.7 pmol/L (P<0.05), but VA/Q, arterial oxygen transport, coefficient of oxygen delivery, and MetHb level were not altered during inhalation of NO. Conclusion The data indicate that the pulmonary blood vessel in COPD-PH can be dilated immediately and selectively, gas exchange in lung can be improved during inhalation of NO , the mechanism of which may be related to increase of cGMP.
出处
《中国动脉硬化杂志》
CAS
CSCD
2000年第3期247-250,共4页
Chinese Journal of Arteriosclerosis
基金
卫生部优秀青年科技人才专项科研基金!(No .Q942 1)
湖北省重点科技基金!(No .941P190 1)资助项目
关键词
阻塞性肺疾病
高血压
一氧化氮
血流动力学
Lung Diseases
Obstructive
Hypertension
Pulmonary
Nitric Oxide
Hemodynamics
Blood Gas Analysis
