一氧化氮吸入治疗急性呼吸窘迫综合征的临床疗效  

Clinical efficacy of inhaled nitric oxide therapy for acute respiratory distress syndrome

作　　者：王璐[1] 左小淑 高文蔚[1] 夏文芳[1] 李光[1] 柳舟[1] 石昭坤 方小雨 李镇文 张浩 宋振举 张召才[4] 邓医宇 邹捍东[1] 詹丽英[1] WANG Lu;ZUO Xiaoshu;GAO Wenwei;XIA Wenfang;LI Guang;LIU Zhou;SHI Zhaokun;FANG Xiaoyu;LI Zhenwen;ZHANG Hao;SONG Zhenju;ZHANG Zhaocai;DENG Yiyu;ZOU Handong;ZHAN Liying(Dept.of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,Macheng Hospital of Traditional Chinese Medicine,Macheng 438300,Hubei,China;Dept.of Emergency,Zhongshan Hospital Fudan University&Institute of Emergency Rescue and Critical Care,Fudan University,Shanghai 200032,China;Dept.of Critical Care Medicine,The Second Affiliated Hospital,Zhejiang University School of Medicine&Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine,Hangzhou 310009,Zhejiang,China;Dept.of Critical Care Medicine,Guangdong Provincial People's Hospital of Southern Medical University&Guangdong Academy of Medical Sciences,Guangzhou 510000,Guangdong,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060 [2]麻城市中医医院重症医学科,湖北麻城438300 [3]复旦大学附属中山医院急诊科/复旦大学应急救援与急危重症研究所,上海200032 [4]浙江大学医学院附属第二医院重症医学科/浙江省急危重症临床医学研究中心,浙江杭州310009 [5]南方医科大学附属广东省人民医院/广东省医学科学院重症医学科,广东广州510000

出　　处：《武汉大学学报(医学版)》2025年第2期187-193,共7页Medical Journal of Wuhan University

基　　金：国家重点研发计划(编号:2021YFC2501800);国家自然科学基金资助项目(编号:82272226);武汉市知识创新专项项目(编号:2023020201010165);武汉大学人民医院交叉创新人才项目(编号:JCRCZN‑2022‑017)。

摘　　要：目的:评估一氧化氮吸入(iNO)联合标准治疗对急性呼吸窘迫综合征(ARDS)患者的影响。方法:采集2019年1月—2024年4月的ARDS患者共406例,按照1∶1倾向性评分匹配(PSM)后,分为iNO联合标准治疗(I+S)组和标准治疗(S)组,每组各35例,评估治疗后患者的平均肺动脉压、动脉氧分压/吸入氧浓度百分比(PaO_(2)/FiO_(2))、28 d死亡率等指标。结果:在治疗24 h和48 h后,I+S组患者的平均肺动脉压显著低于S组(P<0.05)。而且,I+S组的PaO_(2)/FiO_(2)在治疗后显著上升(P<0.05)、可溶性生长刺激表达基因蛋白2(sST2)水平显著下降(P<0.05)。比较两组非机械通气时间、ICU住院时间、持续性肾脏替代治疗(CRRT)和体外膜肺氧合(ECMO)使用率、28 d死亡率,差异无统计学意义(P>0.05)。结论:一氧化氮吸入联合标准治疗在改善ARDS患者的肺动脉压、氧合和心肌标志物方面显示出潜在的益处。Objective:To evaluate the effect of nitric oxide inhalation(iNO)combined with standard therapy on patients with acute respiratory distress syndrome(ARDS).Methods:A total of 406 ARDS patients collected from January 2019 to April 2024 were divided into two groups:the iNO combined with standard treatment(I+S)group and the standard treatment(S)group,with 35 patients in each group,according to a 1∶1 propensity score matching(PSM).The mean pulmonary artery pressure,arterial oxygen pressure/inspiratory oxygen fraction ratio(PaO_(2)/FiO_(2)),28‑day mortality,and other treatment outcomes were evaluated.Results:After 24 and 48 hours of treatment,respectively,the mean pulmonary artery pressure in the I+S group was significantly lower than in the S group(P<0.05).In addition,PaO_(2)/FiO_(2)in the I+S group was significantly increased after treatment(P<0.05),and the sST2 level was significantly decreased(P<0.05).No significant difference was found in the duration of non‑mechanical ventilation,length of ICU stay,use of continuous renal replacement therapy(CRRT)and extracorporeal membrane oxygenation(ECMO),and 28‑day mortality between the two groups(P<0.05).Conclusion:iNO combined with standard therapy shows potential benefits in improving pulmonary artery pressure,oxygenation,and cardiac biomarkers in patients with ARDS.

关 键 词：一氧化氮吸入 急性呼吸窘迫综合征 肺动脉压 预后 

分 类 号：R459.4[医药卫生—治疗学]