陈顺存 钟淑卿 黎毅敏 徐远达 莫红缨 何为群 陈思蓓 钟南山 510120 广州呼吸疾病研究所 中华内科杂志 1998 0 0 12


    关键词：高血压，肺性；低氧；一氧化氮；精氨酸 期刊 zhnkzz 0 论 著 fur -->


    

【摘要 】 目的 探讨吸入一氧化氮(NO)加静注L-精氨酸对缺氧性肺动脉高压的作用。方法 用猪制成低氧性肺动脉高压模型，人工通气，插入Swan-Ganz导管和动脉导管监测血流动力学变化，在吸入低浓度NO(10～15 ppm)的同时静注50% L-精氨酸以及静注一氧化氮合酶(NOS)抑制剂，观察其对肺动脉高压的影响，测量呼出气中NO的含量，检测内皮素及肿瘤坏死因子α等在动脉血中的变化。结果 在吸入低浓度NO同时静注L-精氨酸能显著延长NO的降压作用时间(从5.0±3.6分钟延长至79.8±10.2分钟)，TNFα的含量降低。对体循环血流动力学无影响。静注NOS抑制剂，使肺动脉压进一步上升，部分抵销了L-精氨酸的作用。结论 吸入低浓度NO加静注L-精氨酸，可显著延长NO降低肺动脉高压的作用。

Combination of nitric oxideinhalation with L-arginine injection in prolonging the effect of reducing porcine hypoxicpulmonary hypertension Chen Shuncun,Zhong Shuqing, Li Yimin, et al. Guangzhou Institute of Respiratory Diseases, Guangzhou 510120

【Abstract 】 Objective Toassess the effect of combined use of nitric oxide(NO) inhalation and L-arginine(L-arg)injection in reducingporcine hypoxic pulmonary hypertension. Methods Eight pigs with hypoxic pulmonary hypertension either inhaled NO(10～15 ppm) alone for 15 min or inhaled NO plusintravenous injection of L-arg (10 g). Hemodynamic parameters and concentration of exhaledNO were recorded. Plasma tumor necrosis factor (TNF)α,endothelin (ET)-1 and nitric oxide synthetase in tissue were also assayed. Results NO inhalation significantly decreased the mean pulmonary arterialpressure, but the effect lasted only 3～5 min afterstopping inhalation. Combined administration of L-arg did not decrease mPAP further, butsignificantly prolonged the inhibitory effect of NO inhalation on pulmonary hypertension(≥16 times ) as compared with inhaling NO alone. Plasma TNFα decreased after NO inhalation and L-arg injection(185.8±22.2 ng/Lvs 165.5±25.0 ng/L and 158.7±20.1 ng/L; P≤0.02),but ET-1 was not significantly changed. Conclusion With the inhalation of exogenous NO, supplement of NO substrate L-arg produced a synergetic inhibition effect on hypoxica-induced pulmonary hypertension.Meanwhile TNFα decreased, but further study is neededto know the mechanism.

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