Leuchte Hanno H, Schwaiblmair Martin, Baumgartner Rainer A, Neurohr Claus F, Kolbe Tilman, Behr Jürgen
Department of Internal Medicine I, Section for Pulmonary Diseases, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
Chest. 2004 Feb;125(2):580-6. doi: 10.1378/chest.125.2.580.
Different vasodilators and different routes of application are used for the treatment of primary pulmonary hypertension (PPH). Recently, sildenafil, a phosphodiesterase-V inhibitor, has been shown to have beneficial hemodynamic effects in PPH. However, the hemodynamic effects of sildenafil have not been characterized and compared to other vasodilators such as inhaled nitric oxide (iNO) or iloprost in PPH in the same group of patients.
We investigated prospectively 10 consecutive patients with PPH using iNO, iloprost aerosol, and oral sildenafil to test acute hemodynamic response during right-heart catheterization.
iNO, iloprost aerosol, and sildenafil caused a significant fall of mean pulmonary artery pressure and pulmonary vascular resistance (PVR) [p < 0.05]. Correspondingly, cardiac output and mixed venous saturation increased slightly in all groups. Systemic arterial pressure and vascular resistance were mainly unaltered. Using a PVR reduction of > or =20% to define a significant response, 7 of 10 patients were responders to iloprost aerosol, whereas 4 of 10 patients responded to iNO and oral sildenafil. Improvement of oxygenation as indicated by an increase of arterial oxygen tension was observed with iloprost aerosol (p < 0.01).
All of the three substances, iNO, iloprost aerosol, and oral sildenafil, significantly improved pulmonary hemodynamics in patients with PPH. The most prominent hemodynamic effects and improvement of oxygenation were observed with iloprost aerosol.
不同的血管扩张剂及不同的给药途径用于治疗原发性肺动脉高压（PPH）。最近，磷酸二酯酶-V抑制剂西地那非已被证明对PPH具有有益的血流动力学效应。然而，西地那非的血流动力学效应尚未得到明确描述，也未在同一组PPH患者中与其他血管扩张剂如吸入一氧化氮（iNO）或伊洛前列素进行比较。
我们前瞻性地研究了10例连续的PPH患者，使用iNO、伊洛前列素气雾剂和口服西地那非来测试右心导管检查期间的急性血流动力学反应。
iNO、伊洛前列素气雾剂和西地那非均导致平均肺动脉压和肺血管阻力（PVR）显著下降[p < 0.05]。相应地，所有组的心输出量和混合静脉血氧饱和度均略有增加。体循环动脉压和血管阻力基本未改变。以PVR降低≥20%定义为显著反应，10例患者中有7例对伊洛前列素气雾剂有反应，而10例患者中有4例对iNO和口服西地那非有反应。伊洛前列素气雾剂可使动脉血氧张力升高，从而改善氧合（p < 0.01）。
iNO、伊洛前列素气雾剂和口服西地那非这三种物质均能显著改善PPH患者的肺血流动力学。伊洛前列素气雾剂观察到最显著的血流动力学效应和氧合改善。
