Hoeper M M, Spiekerkoetter E, Westerkamp V, Gatzke R, Fabel H
Department of Respiratory Medicine, Hannover Medical School, Germany.
Eur Respir J. 2002 Aug;20(2):339-43. doi: 10.1183/09031936.02.02462001.
Treatment with aerosolised iloprost, a prostacyclin analogue, has beneficial effects in patients with pulmonary arterial hypertension (PAH). It is unclear if patients, whose clinical condition deteriorates under treatment with aerosolised iloprost, benefit from switching to continuous intravenous iloprost. The current authors report on 16 patients with severe PAH who received continuous intravenous iloprost after primary or secondary failure of treatment with aerosolised iloprost. Determinants of efficacy were survival, New York Heart Association (NYHA) class, and walking distance in the 6-min walk test. Of 93 patients with PAH treated with aerosolised iloprost, 16 required switching to intravenous iloprost for clinical deterioration. These patients had severe right heart failure with a cardiac index of 1.6+/-0.2 L x min(-1) x m(-2) and a mixed-venous oxygen saturation of 52+/-6%. Five of these patients showed no improvement and eventually died. Three patients had further deterioration in NYHA class and exercise capacity; two of them underwent lung transplantation; the third patient is still alive. Eight patients showed marked clinical improvement; one underwent lung transplantation and the others are currently alive and stable. In the latter group of patients, the walking distance in the 6-min walk test increased from 205+/-94 to 329+/-59 m. It was not possible to identify clinical or haemodynamic factors that would predict whether switching from inhaled to intravenous iloprost would have a beneficial effect. In patients with pulmonary arterial hypertension who deteriorated while being treated with aerosolised iloprost, switching to continuous intravenous iloprost caused substantial improvement in exercise capacity in eight of 16 patients but could not prevent progression of pulmonary hypertension in the remaining eight patients. Since it was impossible to predict the individual effects of this approach, intravenous prostaglandin treatment should be considered in pulmonary arterial hypertension patients who deteriorate while receiving iloprost aerosol.
前列环素类似物雾化伊洛前列素治疗对肺动脉高压（PAH）患者有有益作用。目前尚不清楚在雾化伊洛前列素治疗下临床状况恶化的患者改用持续静脉输注伊洛前列素是否有益。本文作者报告了16例严重PAH患者，这些患者在雾化伊洛前列素初次或二次治疗失败后接受了持续静脉输注伊洛前列素治疗。疗效的决定因素为生存率、纽约心脏协会（NYHA）心功能分级以及6分钟步行试验中的步行距离。在93例接受雾化伊洛前列素治疗的PAH患者中，有16例因临床状况恶化而需要改用静脉输注伊洛前列素。这些患者存在严重右心衰竭，心脏指数为1.6±0.2L·min⁻¹·m⁻²，混合静脉血氧饱和度为52±6%。其中5例患者无改善并最终死亡。3例患者的NYHA心功能分级和运动能力进一步恶化；其中2例接受了肺移植；第3例患者仍存活。8例患者临床有明显改善；1例接受了肺移植，其他患者目前存活且病情稳定。在后一组患者中，6分钟步行试验中的步行距离从205±94米增加到329±59米。无法确定可预测从吸入改为静脉输注伊洛前列素是否会产生有益效果的临床或血流动力学因素。在接受雾化伊洛前列素治疗时病情恶化的肺动脉高压患者中，改用持续静脉输注伊洛前列素使16例患者中的8例运动能力有显著改善，但无法阻止其余8例患者的肺动脉高压进展。由于无法预测这种方法的个体效果，对于在接受伊洛前列素气雾剂治疗时病情恶化的肺动脉高压患者，应考虑静脉使用前列腺素治疗。
