急性呼吸不全におけるProstaglandin E1の効果

Effects of prostaglandin E1 on pulmonary circuration and oxygen delivery in patiensts with adult respiratory distrcss syndrome

　急性呼吸不全（ARDS）の治療の目的は，肺のガス交換能を改善し，さらに末梢組織に十分な酸素を供給することにある。PEEPの導入は，ガス交換能の改善に有力な手段となり，その治療に画期的な進歩をもたらした。しかし，血行動態の改善に注目した報告は少なく，またARDSの死亡率も依然として高い。

　今回われわれは，ARDS 8例においてprostaglandinE₁（PGE₁）を投与し，その血行動態，特に肺血管抵抗（PVR）と酸素運搬能（To₂）について検討したので報告する。

The aim of treatment in patients with adult res-piratory distress syndrome (ARDS) is to improve pulmonary gas exchange and tissue oxygen delivery. Positive end-expiratory pressure improves arterial oxygenation in these patients, but mortality of ARDS is still high. We therefore examined whether prostaglandin E₁(PGE₁) could correct the impaire-ment of pulmonary circulation and improve oxy-gen delivery.

PGE1, 0.025 μg/kg/min., was administered intra-venously to 8 patients who had ARDS associated with severe infection. Infusion of PGE₁ resulted in a significant fall in the mean pulmonary arterial pres-sure, mean arterial pressure, pulmonary vascular resistance, and systemic vascular resistance, and an increase in cardiac index, stroke index, tissue oxy-gen delivery, and oxygen consumption. No signifi-cant difference was noted in Q_S/Q_T, although there was a positive correlation between the increase in Q_S/Q_T and the increase in cardiac index (r=0.669).

These results indicate that exogenously adminis-tered PGE₁ possibly increases ventilation-perfusion unenveness but improves pulmonary hemodynam-ics and tissue oxygen delivery.