Shin Byung Seop, Do Young Soo, Lee Byung Boong, Kim Dong Ik, Chung Ik Soo, Cho Hyun Sung, Kim Myung Hee, Kim Gaab Soo, Kim Chung Su, Byun Hong Sik, Shin Sung Wook, Park Kwang Bo
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135-710 Korea.
Radiology. 2005 Jun;235(3):1072-7. doi: 10.1148/radiol.2353040903. Epub 2005 Apr 15.
To retrospectively investigate how repeat injections of absolute ethanol in therapeutic doses, required for multisession sclerotherapy of large high-flow soft-tissue arteriovenous malformations (AVMs) in patients with normal cardiopulmonary function, affect pulmonary arterial pressure (PAP).
Study received approval and waiver of informed consent by institutional review board and was conducted in 16 male and 16 female patients with AVMs who underwent repeat sclerotherapy (142 sessions total) with absolute ethanol from July 1997 to December 2003. PAPs were monitored during first session in all patients. In subsequent sessions, PAP was monitored with pulmonary catheter when predicted single dose of ethanol exceeded 3 mL and total amount exceeded 0.25 mL/kg. PAP was measured in 104 sessions. Serum ethanol levels from blood samples obtained at end of each session were reviewed. PAP parameters were analyzed at beginning and end of each session, and highest value was recorded to assess any increase after repeat therapy. Difference between initial and highest PAP values recorded in a session (Delta(max)) was noted to determine any increase during repeat sessions. Possible relationship was reviewed between this value and amount of ethanol used. For sessions without PAP monitoring, mixed model was used for statistical analysis.
Total ethanol used was variable. In 43 sessions, highest mean PAP exceeded 25 mm Hg. Incidence of sustained pulmonary hypertension (mean PAP > 25 mm Hg) at end of each session was 30.8% (32 of 104 sessions). Initial PAP parameters did not increase or decrease during repeat sessions. No significant changes in Delta(max) of systolic and mean PAP were observed with increasing number of sessions. Rather, Delta(max) of diastolic PAP was reduced after repeat sessions (P = .03). There was no significant correlation between serum ethanol level and PAP parameters at end of sessions. Relationships between Delta(max) values of systolic, mean, and diastolic PAP and total ethanol used were not significant.
High incidence of acute pulmonary hypertension was observed in each sclerotherapy session without lasting effect on PAP.
回顾性研究在心肺功能正常的患者中，对大型高流量软组织动静脉畸形（AVM）进行多疗程硬化治疗所需的治疗剂量无水乙醇重复注射如何影响肺动脉压（PAP）。
本研究经机构审查委员会批准并获得知情同意豁免，于1997年7月至2003年12月对16例男性和16例女性AVM患者进行了重复硬化治疗（共142个疗程），使用无水乙醇。所有患者在首个疗程中均监测了PAP。在随后的疗程中，当预计单次乙醇剂量超过3 mL且总量超过0.25 mL/kg时，使用肺动脉导管监测PAP。在104个疗程中测量了PAP。对每个疗程结束时采集的血样中的血清乙醇水平进行了评估。在每个疗程开始和结束时分析PAP参数，并记录最高值以评估重复治疗后的任何升高情况。记录每个疗程中初始PAP值与最高PAP值之间的差异（Delta(max)），以确定重复疗程期间的任何升高情况。审查该值与所用乙醇量之间可能存在的关系。对于未进行PAP监测的疗程，使用混合模型进行统计分析。
所用乙醇总量各不相同。在43个疗程中，最高平均PAP超过25 mmHg。每个疗程结束时持续性肺动脉高压（平均PAP > 25 mmHg）的发生率为30.8%（104个疗程中的32个）。重复疗程期间初始PAP参数未升高或降低。随着疗程数增加，收缩压和平均PAP的Delta(max)未观察到显著变化。相反，重复疗程后舒张压PAP的Delta(max)降低（P = 0.03）。疗程结束时血清乙醇水平与PAP参数之间无显著相关性。收缩压、平均压和舒张压PAP的Delta(max)值与所用乙醇总量之间的关系不显著。
在每个硬化治疗疗程中均观察到急性肺动脉高压的高发生率，但对PAP无持久影响。
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