Ингаляционный оксид азота при первичной легочной гипертензии: влияние на легочную гемодинамику, газообмен и транспорт кислорода

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/m 2 , all p <0.05). There was a significant improvement in oxygen transport at 20 and 40 ppm nitric oxide (DO 2 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, p a 0 2 and p a C0 2 (all p ≤0.01). Our data show an improvement in pulmonary haemodynamics and oxygen transport in patients with primary pulmonary hypertension.