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一氧化氮在慢性肺心病治疗中的作用
作者姓名:Zhang H  Pang B  Guo S
作者单位:北京红十字朝阳医院呼吸疾病医疗研究中心
基金项目:卫生部“八五”攻关基金资助
摘    要:目的观察吸入一氧化氮(NO)对慢性肺心病急性发作期血流动力学和氧动力学影响,并对其产生机理进行探讨。方法对11例肺心病急性发作期患者给予鼻面罩吸入NO40ppm20分钟。治疗前后测定其血流动力学参数和血浆内皮素1(ET1)含量。并测定血浆NO含量,红细胞膜Ca2+Mg2+ATP酶(钙泵);Na+K+ATP酶(钠泵)活性及过氧化脂质含量。结果治疗前后肺动脉平均压(PAPM)和肺血管阻力指数分别下降166%及259%(P<005);肺血分流率下降163%(P<005),ET1含量下降并与PAPM呈正相关,慢性肺心病急性发作期NO含量下降,钙泵与钠泵活性降低,与NO含量呈正相关与过氧化脂质呈负相关。结论吸入NO对肺心病急性发作期患者有良好的血流动力学和氧动力学效应,抑制ET1的释放可能是舒张肺血管的重要机理之一。

关 键 词:一氧化氮  肺心病  内皮缩血管肽类

Nitric oxide in the treatment of COPD-induced chronic cor pulmonale: therapeutic effect and mechanism
Zhang H,Pang B,Guo S.Nitric oxide in the treatment of COPD-induced chronic cor pulmonale: therapeutic effect and mechanism[J].National Medical Journal of China,1998,78(5):347-349.
Authors:Zhang H  Pang B  Guo S
Institution:Beijing Red Cross Chaoyang Hospital, Beijing Respiratory Disease Research Center.
Abstract:OBJECTIVE: To study the hemodynamic and oxygen-dynamic effects and the mechanism of nitric oxide (NO) inhalation therapy in COPD-induced chronic cor pulmonale at acute exacerbation period. METHOD: Right heart catheterization was performed in 11 cases of chronic cor pulmonale. The hemodynamic parameters and plasma endothelium-I(ET-I) level were examined and recorded before and after inhalation of 40 ppm NO for 20 minutes. The plasma level of NO and lipid peroxide Ca(2+)-Mg(2+)-ATPase(calcium pump) and Na(+)-K(+)-ATPase (natrium pump) activities of RBC membrane in 30 cases of chronic cor pulmonale and 30 healthy controls were determined synchronously. RESULTS: After NO therapy, the average pulmonary pressure (PAPM) and pulmonary vascular resistance index (PVRI) were lowered by 16.6% and 25.9% respectively (P < 0.05). Intrapulmonary shunt was lowered by 16.3% (P < 0.05). ET-I also lowered and showed a positive correlation with PAPM (r = 0.59, P < 0.05). The activities of calcium and natrium pump were lowered when NO level declined, showing a positive correlation with NO concentration and negative correlation with lipid peroxides. CONCLUSION: No inhalation therapy exerted favorable hemodynamic and oxygen-dynamic effects on COPD-induced chronic cor pulmonale in its exacerbation period. Suppression of ET-I release might be one of the important factors for pulmonary vessel relaxation. Dysfunction of calcium and natrium pump activities in the acute exacerbation period of chronic cor pulmonale were closely related to NO level.
Keywords:Nitric oxide    Pulmonary heart  disease    Endothelins  
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