Alpert M A, Pressly T A, Mukerji V, Lambert C R, Mukerji B, Panayiotou H, Sharp G C
Department of Internal Medicine, University of South Alabama College of Medicine, Mobile.
Am J Cardiol. 1991 Dec 15;68(17):1687-91. doi: 10.1016/0002-9149(91)90330-n.
Ten patients with pulmonary hypertension associated with diffuse systemic sclerosis (1 patient), the CREST syndrome (calcinosis cutis, Reynaud's phenomenon, esophageal dysmotility, sclerodactyl, telangiectasia) (6 patients) and mixed connective tissue disease (3 patients) were studied to assess the effect of oral nifedipine on pulmonary and systemic hemodynamics. Each patient underwent right-sided cardiac catheterization just before nifedipine administration. Thereafter, oral nifedipine was administered in 10 mg increments every 90 minutes until pulmonary vascular resistance normalized or a total dose of 30 mg was achieved. Hemodynamic measurements were obtained at 30-minute intervals for 3 hours, then hourly for 9 hours (acute study). Hemodynamic studies were repeated 3 to 6 months after the initial catheterization with the minimum dose of oral nifedipine (administered every 8 hours) required to achieve maximal reduction of pulmonary vascular resistance in the acute study (long-term study). In the acute study, oral nifedipine produced a significant decrease in mean pulmonary vascular resistance from 6.3 +/- 3.8 to 4.3 +/- 3.6 U (p less than 0.001). Similar changes in pulmonary vascular resistance were noted in the long-term study (n = 6). The results indicate that oral nifedipine is capable of producing an acute and sustained reduction in pulmonary vascular resistance in patients with pulmonary hypertension associated with diffuse systemic sclerosis, the CREST syndrome and mixed connective tissue disease.
对10例患有与弥漫性系统性硬化症相关的肺动脉高压患者（1例）、CREST综合征（皮肤钙质沉着、雷诺现象、食管运动障碍、硬皮病、毛细血管扩张）患者（6例）和混合性结缔组织病患者（3例）进行了研究，以评估口服硝苯地平对肺和全身血流动力学的影响。每位患者在服用硝苯地平前均接受了右心导管检查。此后，每90分钟以10mg的增量口服硝苯地平，直至肺血管阻力恢复正常或达到30mg的总剂量。在3小时内每隔30分钟进行一次血流动力学测量，然后在接下来的9小时内每小时测量一次（急性研究）。在首次导管检查后3至6个月，重复进行血流动力学研究，使用急性研究中使肺血管阻力最大程度降低所需的最小剂量口服硝苯地平（每8小时服用一次）（长期研究）。在急性研究中，口服硝苯地平使平均肺血管阻力从6.3±3.8降至4.3±3.6U（p＜0.001）。在长期研究（n = 6）中也观察到了类似的肺血管阻力变化。结果表明，口服硝苯地平能够使患有与弥漫性系统性硬化症、CREST综合征和混合性结缔组织病相关的肺动脉高压患者的肺血管阻力急性和持续降低。
