pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLCpulmo-2849Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESИнгаляционный оксид азота при первичной легочной гипертензии: влияние на легочную гемодинамику, газообмен и транспорт кислородаInhaled nitric oxide in primary pulmonary hypertension: effects on pulmonary haemodynamics, gas exchange and oxygen transportАвдеевС. Н.AvdeevS. N.

Москва

ЦареваН. А.TsarevaN. A.

Москва

НеклюдоваГ. В.NekludovaG. V.

Москва

ЧазоваИ. Е.ChazovaI. E.

Москва

ЧучалилЛ. Г.ChuchalinA. G.

Москва

НИИ пульмонологии М3Russian FederationНИИ кардиологии им. А.Л. Мясникова РКНПК М3Russian Federation200130122001043439Copyright © Авдеев С.Н., Царева Н.А., Неклюдова Г.В., Чазова И.Е., Чучалил Л.Г., 20012001Авдеев С.Н., Царева Н.А., Неклюдова Г.В., Чазова И.Е., Чучалил Л.Г.Avdeev S.N., Tsareva N.A., Nekludova G.V., Chazova I.E., Chuchalin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2849

В статье изучены эффекты ингаляционного оксида азота (N0) на легочную гемодинамику, газообмен и транспорт кислорода у больных с первичной легочной гипертензией (ПЛГ) и факторы-предикторы ответа на N0. Наблюдали 10 больных (8 женщин, 2 мужчин) с ПЛГ.

Параметры гемодинамики и оксигенации измерялись до начала исследования и последовательно в конце сеансов ингаляции N0 в концентрациях 10, 20, и 40 ppm (через 15 мин). Пациенты считались “ответчиками” при наличии снижения среднего давления в легочной артерии или легочного сосудистого сопротивления более чем на 20%. Для постоянного контроля N0 и N02 был использован электрохимический анализатор PrinterNOx.

На фоне терапии N0 наблюдалось дозозависимое улучшение легочной гемодинамики, максимальный эффект отмечен при N0 40 ppm (среднее легочное давление снизилось с 67±7 до 56±5 л/мин/м2, легочное сосудистое сопротивление – с 335±302 до 790±102 дин-с/см-5 и сердечный индекс увеличился с 2,3 до 2,7 L/min/m2, р<0,05). При N0 20 и 40 ppm наблюдалось значимое улучшение транспорта кислорода (от 684±108 до 791 ± 110 и 835±98 соответственно, р< 0,05). Пять больных (50%) ответили на терапию N0. “Ответчики” отличались от "неответчиков" по таким показателям, как дистанция во время теста с 6-минутной ходьбой, ра02 и раС02 (р<0,01).

Ингаляционный оксид азота достоверно улучшает показатели легочной гемодинамики и газообмена у больных с ПЛГ.

The study assess effects of inhaled nitric oxide on pulmonary haemodynamics, gas exchange and oxygen transport in patients with primary pulmonary hypertension (PPH) and evaluates factors predicting the response to inhaled nitric oxide.

Ten patients with PPH (8 females, 2 males) were observed.

Oxygenation and haemodynamic variables were measures and calculated at room air and then 15 min after each sequential addition of 10, 20 and 40 ppm nitric oxide to the gas mixture. Patients were considered responders if the mean pulmonary artery pressure or pulmonary vascular resistance decreased by 20%. An electrochemical gas sensor device PrinterNOx provided continuous analysis of nitric oxide and oxidative nitric oxide products.

There was a dose-dependent improvement in haemodynamic variables that was maximal at 40 ppm nitric oxide (mean pulmonary artery pressure decreased from 67±7 to 56±5 mm Hg, pulmonary vascular resistance index decreased from 1335±302 to 790±102 dyne sec/cm-5, and cardiac index increased from 2.3 to 2.7 L/min/m2, all p<0.05). There was a significant improvement in oxygen transport at 20 and 40 ppm nitric oxide (DO2 improved from 684±108 to 791±110 and 835±98, respectively, p<0.05). Five patients (50%) responded to NO. The responders differed from non-responders in such factors as distance during 6-minute walking test, pa02 and paC02 (all p≤0.01).

Our data show an improvement in pulmonary haemodynamics and oxygen transport in patients with primary pulmonary hypertension.

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The authors declare that there are no conflicts of interest present.