Jansa P, Aschermann M, Lindner J, Palecek T, Ambroz D, Linhart A
Centrum pro plicní hypertenzi, II. interní klinika kardiologie a angiologie 1, LF UK a VFN, Praha.
Cas Lek Cesk. 2006;145(4):264-8.
Pulmonary hypertension is defined as the rise of mean pressure in the pulmonary artery over 25 mmHg at rest or over 30 mmHg during activity with accompanying increase of pulmonary vascular resistance over 3 WU (Wood's unit). According to the recent WHO classification from 2003 pulmonary hypertension can be categorized as pulmonary arterial hypertension, pulmonary venous hypertension, hypoxic pulmonary hypertension, chronic thromboembolic pulmonary hypertension and pulmonary hypertension from other causes. Because symptoms of the pulmonary hypertension are non-specific, the diagnosis is frequently late. Patients with higher risk of pulmonary hypertension require frequent echocardiographic examination. Treatment of the pulmonary hypertension is rather complex and economically demanding. It should be therefore centralized in specialized units. Decision on the pharmacotherapy is based on the acute pulmonary vasodilatation test. Only patients with the positive test (10% of patients) are indicated to the treatment with calcium channel blockers. In case of negative test, the treatment of choice in NYHA III stadium is bosentam per orally, in the NYHA IV stadium it is epoprostenol intravenously. In patients with chronic thromboembolic pulmonary hypertension, organized thrombotic material should be surgically removed together with the layer of the pulmonary artery (pulmonary endarterectomy) after preceding anticoagulation treatment lasting at least three months. Pulmonary hypertension center of the Cardiocenter of the General teaching hospital is the only unit in the Czech Republic which beside the complex therapy of the pulmonary arterial hypertension can employ also the surgical treatment of the chronic thromboembolic pulmonary hypertension.
静息时肺动脉平均压超过25 mmHg，或活动时超过30 mmHg，同时肺血管阻力超过3 WU（伍德单位）。根据世界卫生组织2003年的最新分类，肺动脉高压可分为动脉性肺动脉高压、静脉性肺动脉高压、低氧性肺动脉高压、慢性血栓栓塞性肺动脉高压以及其他原因所致的肺动脉高压。由于肺动脉高压的症状不具有特异性，诊断往往较晚。肺动脉高压风险较高的患者需要频繁进行超声心动图检查。肺动脉高压的治疗相当复杂，且费用高昂。因此，应集中在专科单位进行治疗。药物治疗的决策基于急性肺血管扩张试验。只有试验结果为阳性的患者（占患者总数的10%）才适合使用钙通道阻滞剂进行治疗。如果试验结果为阴性，纽约心脏协会（NYHA）心功能III级的患者首选口服波生坦治疗，NYHA心功能IV级的患者则首选静脉注射依前列醇治疗。对于慢性血栓栓塞性肺动脉高压患者，在至少进行三个月的抗凝治疗后，应通过手术切除有组织的血栓物质及肺动脉内膜（肺动脉内膜切除术）。综合教学医院心脏中心的肺动脉高压中心是捷克共和国唯一一家除了能进行动脉性肺动脉高压综合治疗外，还能开展慢性血栓栓塞性肺动脉高压外科治疗的单位。
