pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2015-25-2-180-186pulmo-552Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESИнгаляционный оксид азота: возможности улучшения оксигенации при остром респираторном дистресс-синдромеInhaled nitric oxide: way to improve oxygenation in acute respiratory distress syndromeШтабницкийВ. А.ShtabnitskiyV. A.

ассистент кафедры госпитальной терапии педиатрического факультета ГБОУ ВПО «РНИМУ им. Н.И.Пирогова» Минздрава России; научный сотрудник ФГБУ «НИИ пульмонологии» ФМБА России; тел.: (495) 465-52-64

Assistant Lecturer, Department of Hospital Internal Medicine. Pediatric Faculty, State Institution "N.I.Pirogov Russian National Research Medical University", Healthcare Ministry of Russia; tel.: (495) 465-52-64;

vashtab@rambler.ruЧучалинА. Г.ChuchalinA. G.

д. м. н., профессор, академик РАМН, директор ФГБУ «НИИ пульмонологии» ФМБА России, зав. кафедрой внутренних болезней педиатрического факультета ГБОУ ВПО «РНИМУ им. Н.И. Пирогова» Минздрава России, председатель правления РРО, главный внештатный специалист терапевт-пульмонолог Минздрава России; тел. / факс: (495) 465-52-64;

MD, Professor, Academician of Russian Science Academy, Director of Federal Institution "Pulmonology Research Institute", Federal Medical and Biological Agency of Russia; Head of Department of Hospital Internal Medicine, Pediatric Faculty, State Institution "N.I.Pirogov Russian National Research Medical University", Healthcare Ministry of Russia; President of Russian Respiratory Society; Chief Therapeutist and Pulmonologist of Healthcare Ministry of Russia; tel. / fax: (495) 465-52-64

chuchalin@inbox.ruФГБУ «НИИ пульмонологии» ФМБА России: 105077, Москва, ул. 11-я Парковая, 32, корп. 4 ГБОУ ВПО «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Минздрава России: 117997, Москва, ул. Островитянова, 1РоссияFederal Institution "Pulmonology Research Institute", Federal Medical and Biological Agency of Russia; 32, build. 4, 11th Parkovaya str., Moscow, 105077, Russia; State Institution "N.I.Pirogov Russian National Research Medical University", Healthcare Ministry of Russia; 1 Ostrovityanova str., Moscow, 117997, RussiaRussian Federation201524062015252180186Copyright © Штабницкий В.А., Чучалин А.Г., 20152015Штабницкий В.А., Чучалин А.Г.Shtabnitskiy V.A., 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/552

Несмотря на общий прогресс при ведении пациентов с острым респираторным дистресс-синдромом (ОРДС), общая летальность продолжает оставаться высокой. Обязательным компонентом ведения больных с ОРДС является искусственная вентиляция легких. При назначении таким пациентам ингаляционного оксида азота (iNO) в целях улучшения оксигенации эффективно улучшается газообмен. Цель: определение места iNO в комплексной терапии ОРДС. Материалы и методы: в исследовании принимали участие пациенты с ОРДС (n = 30) среднетяжелого и тяжелого течения. Индекс оксигенации (ИО) (отношение показателей парциального давления кислорода в артериальной крови – PaO2 и содержания кислорода во вдыхаемом воздухе – FiO2) составил 113,3 ± 33,7; фракция шунта (Qs / Qt) – 40,5 ± 12,9 %; оценка по шкалам степени тяжести Acute Physiology And Chronic Health Evaluation II (APACHE II) – 20,3 ± 1,9 балла, повреждения легких (Lung Injury Score) – 2,7 ± 0,7 балла. С целью улучшения оксигенации всем пациентам назначался iNO в дозе от 5 ppm, критерием ответа на терапию был прирост ИО PaO2 / FiO2 > 20 %. Результаты: ответ на терапию отмечен у 62 % больных; наблюдался закономерный прирост ИО PaO2 / FiO2 со 107,5 до 172,5 (p < 0,05); уменьшение Qs / Qt – c 39,3 до 27,9 (p < 0,05). У ответивших на терапию пациентов достоверно отмечались более выраженное нарушение оксигенации и нормальные показатели центральной гемодинамики; iNO не оказывал влияния на прогноз при ОРДС; медиана выживаемости была на 3 дня больше у больных, получавших iNO, однако данная разница была статистически недостоверной. Заключение: iNO является одним из эффективных способов улучшения оксигенации при ОРДС. На терапию iNO лучше отвечают пациенты с тяжелым ОРДС и нормальными показателями центральной гемодинамики.

Acute respiratory distress syndrome (ARDS) is an actual problem of the modern medicine. Despite current progress in management of such patients, an all-cause mortality is still very high. Mandatory approach to all ARDS patients is mechanical ventilation (MV). There are several additional ways to increase oxygenation rate in ARDS; inhaled nitric oxide (iNO) is one of them. Aims: The aim of our study was to determine a role of iNO in therapy of ARDS. Methods. We involved 30 patients with moderate to severe ARDS, PaO2 / FiO2, 113.3 ± 33.7; Qs / Qt, 40.5 ± 12.9 %; APACHE II score, 20.3 ± 1.9; Lung Injury Score, 2.7 ± 0.7. iNO was administered to all patients in a starting dose of 5 ppm titrated to get positive response with PaO2 / FiO2 increase > 20 % from baseline. Results. 62 % of patients positively responded to the therapy. We observed an increase in PaO2 / FiO2 from 107.5 to 172.5 (p < 0.05) and a decrease in Qs / Qt from 39.3 to 27.9 (p < 0.05). Responders had statistically significantly worse oxygenation and better hemodynamics (cardiac output) parameters comparing to non-responders. iNO did not alter survival rate; patients treated with iNO had median survival time 3 days longer but this difference was not statistically significant. Conclusions. iNO is an effective way to improve oxygenation in ARDS patients. Better response was seen in patients with severe ARDS and stable central hemodynamics.

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