【摘要】 目的　探讨血浆内皮素 1 (ET 1 )、一氧化氮 (NO)及ET/NO对急性肺损伤 (ALI)患者肺循环动力学及呼吸力学的影响。方法ALI患者 8例 (ALI组 )和非ALI患者 1 1例 (nALI组 )经右心导管监测血液动力学指标 :心率 (HR)、平均肺动脉压 (MPAP)、收缩期肺动脉压 (SPAP)、舒张期肺动脉压 (DPAP)及肺血管阻力 (PVR) ,计算肺血管阻力 /系统血管阻力 (PVR/SVR)。用热稀释法测心输出量 (CO)。即刻抽取肺动脉血及股动脉血作血气分析 ,再取肺动脉血保存 ,用放射免疫法测血浆ET 1含量 ,用比色法测血清NO含量 ;所有患者均行气管插管及机械通气 ,治疗中监测呼吸力学指标 :呼吸频率 (RR)、吸气峰值压 (PIP)、平台压 (Pplat)。计算气道阻力 (Raw)及肺顺应性 (Cst)。结果ALI组SPAP、DPAP、MPAP、PVR及PVR/SVR较nALI组均显著升高 (P <0 0 5) ,RR、PIP、Pplat及Raw亦明显高于nALI组 (P <0 0 5) ,而Cst和PaO2 显著低于nALI组 (P<0 0 5) ;血浆ET 1含量明显高于nALI组 (P <0 0 0 1 ) ,血清NO水平显著低于nALI组 (P <0 0 1 ) ,ET/NO则明显高于nALI组 (P <0 0 5)。血浆ET 1含量与肺损伤评分 (LIS)、SPAP、MPAP、PVR/SVR及气道阻力均呈显著正相关 ;NO则与PaO2 呈显著正相关 ;ET/NO与PaO2 呈显著负相关 ,与其它指标则无显著相关?更多还原

【Abstract】 Objective To explore the effects of plasma endothelin 1(ET 1),sera nitric oxide(NO),and ET/NO on hemodynamics and respiratory parameters in patients with acute lung injury Methods Eight patients with acute lung injury(group ALI) and eleven patients without acute lung injury (group nALI) were studied.All patients required tracheal intubation and mechanical ventilaton Cardiac catheterization was performed in all patients to monitor their pulmonary hemodynamic parameters,ie heart rates (RR),mean pulmonary arterial pressure (MPAP),systolic pulmonary arterial pressure (SPAP),diastolic pulmonary arterial pressure (DPAP) and pulmonary vascular resistance (PVR) were measured by a monitor and the resistance ratio (PVR/SVR) was calculated Cardiac output (CO) was measured by the thermodilution method using a computer Analysis of arterial blood gas was simultaneously determined which blood samples were obtained from the pulmonary artery and the radial artery Blood samples were obtained from the pulmonary artery were stored until analysis Plasma ET 1 levels were measured by a specific radioimmunoassay Serum NO levels were measured by colorimetric analysis Respiratory parameters including respiratory rate (RR),peak inspiratory pressure (PIP),and plateau pressure(Pplat) were monitored by the ventilator during ventilation Airway resistance (Raw) and lung static compliance (Cst) were calculated ResultsAmong the hemodynamic parameters,SPAP,DPAP,MPAP,PVR,and PVR/SVR in patients with ALI were significantly higher than those of patients without ALI( P <0 05,respectively) The respiratory parameters in two groups were distinct as RR,PIP,Pplat,and Cst were significantly higher in Group ALI and lung static compliance was significantly lower ( P <0 05,respectively) Artery oxygen tension(PaO 2 ) of patients with ALI were also significantly lower ( P <0 05) The plasma ET 1 levels in patients with ALI were significantly higher than those of patients without ALI The serum NO levels in patients with ALI were significantly lower The ratio of ET/NO in group ALI was (8 33±3 22),which was significantly higher than that of patients in group nALI(1 74±0 76, P <0 05) In the patients with ALI,plasma ET 1 levels correlated positively with lung injury score ( r = 0 894 3 , P <0 005),SPAP( r = 0 970 1 , P <0 005),MPAP ( r = 0 976 9 , P <0 005),and the resistance ratio (PVR/SVR) ( r = 0 910 2 , P <0 005),as well as airway resistance( r = 0 778 8 , P <0 05) While a significantly positive correlation was revealved between serum NO levels and PaO 2 ( r = 0 966 3 , P <0 001),the ratio of ET/NO was negatively correlated with PaO 2 ( r = -0 843 7 , P <0 01) No correlation was demonstrated for other parameters ConclusionsOur results demonstrate an inverse tendency of ET 1 and NO in the process of lung injury,implying the imbalance of ET and NO may contribute to pulmonary hypertension and increased airway resistance Measuring plasma ET 1 levels of patients with ALI is useful in evaluating the severity of lung impairment To rectify hypoxia and unbalanced ratio of ET/NO may play important role in prevention and treatment of ALI更多还原