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成人呼吸窘迫综合征(ARDS)的主要表现为肺动脉高压(其程度与微血管损害程度相关)、高渗透性肺水肿以及由于自右至左的静脉血分流而致通气(VA)与灌注(Q)失配。输注前列环素(PGI_2)与前列腺素E_1(PGE_1)等前列腺素类血管扩张剂可降低肺微血管压力,因而可减少肺内液体的滤过量及降低右心后负荷。然而输注前列腺素类药物缺乏选择性,表现为血管扩张可发生于肺部及全身的血管,亦可发生于通气与非通气的肺区。在ARDS动物模型、严重ARDS患者与肺动脉高压患者中,用一氧化氮吸入可克服上述缺点。使血管扩张仅局限于肺循环,并且动脉氧合作用改善,这说明血管舒张主要表现于通气良好的肺区。本文报道3例ARDS用PGI_2吸入对血液动力学与气体交换的影响。
The main manifestations of adult respiratory distress syndrome (ARDS) are pulmonary hypertension (which is related to the extent of microvascular damage), hyperpermeability pulmonary edema, and hyperventilation (VA) and perfusion (Q) due to right to left venous shunts lost pair. Prostaglandin vasodilators such as prostacyclin (PGI_2) and prostaglandin E_1 (PGE_1) can reduce pulmonary microvascular pressure, thereby reducing fluid filtration in the lungs and reducing post-right-heart load. However, the lack of selectivity of the infusion of prostaglandin drugs, manifested as vasodilation can occur in the lungs and systemic blood vessels, can also occur in ventilated and non-ventilated lung area. In ARDS animal models, patients with severe ARDS and pulmonary hypertension, inhalation of nitric oxide can overcome these shortcomings. Vasodilatation is confined to the pulmonary circulation only, and arterial oxygenation is improved, indicating that vasodilation is predominantly manifested in a well-ventilated lung area. This article reports the effects of three inhaled ARDS with PGI_2 on hemodynamics and gas exchange in ARDS.