Romano P M, Peterson S
New York Medical College and Taylor Care Center, 25 Bradhurst Avenue, Hawthorne, NY 10532, USA.
Heart Dis. 2000 Nov-Dec;2(6):431-7.
Pulmonary artery hypertension occurs when there is a sustained elevation of the mean pulmonary pressure above normal physiologic values. This may then lead to cor pulmonale or enlargement of the right ventricle due to any lung disease in the absence of left heart failure. When the ability of the right ventricle to compensate is overwhelmed, right-sided heart failure can occur. Pulmonary artery hypertension may be idiopathic (primary) or secondary to a variety of lung parenchymal diseases, airways disease, pulmonary circulatory disorders, systemic illnesses, or thoracic mechanical abnormalities. Treatment strategies for cor pulmonale include supplemental oxygen, assisted mechanical ventilation, digoxin, and diuretics. Pulmonary vasodilator compounds should be used with caution because they can compromise gas exchange in cor pulmonale from secondary pulmonary hypertension. Trials with digoxin and inotropic agents have been evaluated. Angiotensin-converting enzyme inhibitors have not shown significant utility, at least acutely. Anticoagulation may decrease mortality in some patients with pulmonary artery hypertension and cor pulmonale.
当平均肺动脉压持续高于正常生理值时，就会发生肺动脉高压。在没有左心衰竭的情况下，这可能会因任何肺部疾病导致肺心病或右心室扩大。当右心室的代偿能力不堪重负时，就会发生右侧心力衰竭。肺动脉高压可能是特发性（原发性）的，也可能继发于多种肺实质疾病、气道疾病、肺循环障碍、全身性疾病或胸廓机械异常。肺心病的治疗策略包括补充氧气、辅助机械通气、地高辛和利尿剂。肺血管扩张剂应谨慎使用，因为它们会损害继发于肺动脉高压的肺心病患者的气体交换。已经评估了地高辛和正性肌力药物的试验。血管紧张素转换酶抑制剂至少在急性情况下未显示出显著疗效。抗凝治疗可能会降低一些肺动脉高压和肺心病患者的死亡率。
