NO吸入降低高原肺水肿患者肺动脉高压的动态观察  

Nitric oxide inhalation reduces pulmonary hypertension in patients with high altitude pulmonary edema

作　　者：牟信兵[1] 叶刚林[1] 汤红亚[1] 周小波[1] 陈光林[1] 

机构地区：[1]西藏军区总医院全军高山病防治研究中心,拉萨850003

出　　处：《中华航空航天医学杂志》2003年第4期234-237,共4页Chinese Journal of Aerospace Medicine

摘　　要：目的　了解NO吸入对高原肺水肿的治疗作用及突然停止吸入NO引起的肺动脉压反跳作用。　方法　采用右心漂浮导管检测法 ,观察了 7例高原肺水肿患者吸入NO及突然停止吸入NO后血流动力学及动脉血气等指标的变化 ,同时采用Lake评分法对患者的病情进行定量评估。　结果　吸入NO 5min后 ,高原肺水肿患者的肺循环阻力、肺动脉平均压明显下降 ,血氧分压明显升高 ,而对心率、体动脉压平均值、心输出量等指标无明显影响 ;高原肺水肿患者在突然停止吸入NO而改吸室内空气后 ,下降的肺动脉压迅速反弹 ,5min后肺动脉压已明显高于吸入NO前水平 ,10min后肺动脉压反跳达最高值 ,与此同时 ,患者的血氧分压明显下降 ,病情定量分数已显著高于吸入NO前水平。　结论　吸入NO对高原肺水肿患者肺动脉高压有选择性降低作用 ,对体循环压无明显影响 ,吸入NO的高原肺水肿患者 ,在短时间吸NO突然撤离后 。Objective To evaluate the therapeutic effects of nitric oxide inhalation in patients with high altitude pulmonary edema(HAPE), and observe the rebound reaction after sudden withdrawal of NO inhalation. Methods Seven HAPE patients served as subjects. Parameters of hemodynamics and arterial blood gases were measured by Swan Ganz thermistor catheters before, during and after NO (10 mg/L) inhalation for 30 min, and the clinical severity score of HAPE was assessed by Lake Louise acute mountain sickness scoring system respectively. Results During NO inhalation, the pulmonary circulation resistance (PCR), mean pulmonary arterial pressure(mPAP) and HAPE severity score decreased significantly, PaO 2 increased significantly, while systemic blood pressure(SAP) and cardiac output (CO) remained unchanged. After room air was given instead of inhaled NO, PCR, mPAP and HAPE severity score of patients quickly rebounded in a few minutes to the levels higher than those before NO inhalation. Conclusion NO inhalation can selectively lower the pulmonary hypertension of HAPE without systemic vasodilation. The rebound reaction to short period of NO inhalation does exist, so intermittent NO inhalation should be avoided, and corresponding measures should be taken during withdrawal of NO inhalation.

关 键 词：一氧化氮 高原肺水肿 缺氧性肺动脉高压 反弹作用 

分 类 号：R594.3[医药卫生—内科学]