吸入された酸化窒素と酸素の効果は,高海拔の肺腫に起因する
I S Anand1, B A Prasad, S S Chugh
1VA Medical Center and University of Minnesota, Minneapolis, MN, USA. anand001@maroon.tc.umn.edu
Circulation
|December 1, 1998
まとめ
窒素酸化物 (NO) を酸素と併用して吸入すると,高空肺腫 (HAPE) の治療に効果が期待される. この組み合わせは,いずれかの治療単独よりも肺の血液動力学とガス交換をより効果的に改善します.
科学分野:
- 肺内医学 肺内医学 肺内医学
- 心血管生理学 心血管の生理学
- クリティカルケアでは,
背景:
- 高地肺腫 (High-altitude pulmonary edema,HAPE) は,肺高血圧,毛細血管の浸透性の増加,低酸素症によって特徴づけられる,生命を脅かす疾患である.
- HAPEの現在の治療法は,下降と酸素投与に限定されています.
- 根本的な病理生理学は,新しい治療的介入を必要とします.
研究 の 目的:
- 吸入された酸化窒素 (NO),50%の酸素,およびNOと50%の酸素の組み合わせが,重度のHAPE患者の血液動力学とガス交換に及ぼす急性効果を調査する.
- これらの介入の有効性および潜在的なシナージー効果を評価する.
主な方法:
- ランダム化され,コントロールされた研究で,重度のHAPEを持つ14人の患者が参加しました.
- 吸入した窒素酸化物 (NO),50%の酸素,そしてNOと50%の酸素の混合物をランダムにそれぞれ30分間投与し,その後は洗浄期間を設けます.
- 肺血管抵抗,全身の血液動力学,ガス交換パラメータ (PaO2, AaDO2) の測定.
主要な成果:
- 吸入されたNOは,全身的血液動力学に影響を与えることなく,肺血管抵抗を36%選択的に減少させた.
- 酸素だけでは,肺血管抵抗を23%低下させました.
- NOと50%の酸素の組み合わせは,肺血管抵抗を54%大幅に低下させた.
- 吸入されたNO単独はPaO2を14%,AaDO2を31%改善した.
- NOと50%の酸素の組み合わせは,酸素単独と比較して,AaDO2 (-18%) とPaO2 (+21%) でより大きな改善を示しました.
結論:
- 吸入されたNOは,高高度肺腫 (HAPE) の管理において治療的可能性を示しています.
- 吸入されたNOと酸素の併用投与は,肺の血液動力学に添加的効果と,ガス交換に優越的な効果を示しています.
- これらの発見は,酸素とNOがHAPEにおける肺血管系内の異なる相互作用するメカニズムを標的とする可能性があることを示唆しています.
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