University of Oklahoma Health Sciences Center, Pulmonary and Critical Care Medicine, Oklahoma City, OK 73104, USA.
Respiration. 2010;79(5):377-82. doi: 10.1159/000242498. Epub 2009 Sep 25.
Nonselective systemic vasodilators worsen ventilation perfusion (V/Q) matching and gas exchange in patients with chronic obstructive pulmonary disease (COPD). Inhaled iloprost has the potential to act preferentially in ventilated regions of the lung, thereby reducing pulmonary hypertension (PH) while alveolar ventilation is still maintained.
To investigate the acute effects of inhaled iloprost on V/Q matching in patients with COPD and PH.
Ten males with COPD and PH on echocardiography were evaluated before and after inhaling 2 doses of iloprost (2.5 microg). Measurements included lung function, arterial blood gas, 6-min walk test (6MWT) as well as ventilatory equivalents for oxygen (V(E)/VO(2)) and carbon dioxide (V(E)/VCO(2)) taken at baseline, 30 min following each dose of iloprost, and 2 h after the second dose.
Mean differences in V(E)/VCO(2) and V(E)/VO(2) were -13.3 (95% CI -36.5 to -2.7; p = 0.002) and -15.0 (95% CI -36.7 to -0.4; p = 0.02), respectively, and the mean change in (A-a) gradient was -3.7 mm Hg (95% CI -6.1 to -1.0; p = 0.01) after a single dose of iloprost, whereas mean improvement in 6MWT was 49.8 m (95% CI 14.8 to 84.7; p = 0.02). Arterial blood gas, venous admixture, dead space fraction and lung functions were maintained after iloprost. The effects of iloprost were reproducible after the second dose. All measurements returned to baseline 2 h after the last dose. No adverse effects on systemic blood pressure or oxygen saturation were seen.
Iloprost inhalation was safe in patients with COPD and PH, and was associated with improved V/Q matching and exercise tolerance.
非选择性全身血管扩张剂会使慢性阻塞性肺疾病（COPD）患者的通气-灌注（V/Q）匹配和气体交换恶化。吸入伊洛前列素有可能优先作用于肺部通气区域，从而降低肺动脉高压（PH），同时保持肺泡通气。
研究吸入伊洛前列素对 COPD 和 PH 患者 V/Q 匹配的急性影响。
对超声心动图显示患有 COPD 和 PH 的 10 名男性患者，在吸入 2 剂伊洛前列素（2.5μg）前后进行评估。测量包括肺功能、动脉血气、6 分钟步行试验（6MWT）以及在基线、吸入伊洛前列素后 30 分钟以及第二剂后 2 小时时的氧通气当量（V(E)/VO(2))和二氧化碳通气当量（V(E)/VCO(2))。
V(E)/VCO(2)和 V(E)/VO(2)的平均差值分别为-13.3（95%CI -36.5 至 -2.7；p = 0.002）和-15.0（95%CI -36.7 至 -0.4；p = 0.02），单次吸入伊洛前列素后（A-a）梯度的平均变化为-3.7mmHg（95%CI -6.1 至 -1.0；p = 0.01），而 6MWT 的平均改善为 49.8m（95%CI 14.8 至 84.7；p = 0.02）。伊洛前列素后动脉血气、静脉混合、死腔分数和肺功能保持不变。第二剂伊洛前列素后，其效果具有可重复性。末次给药后 2 小时，所有测量值均恢复至基线。未观察到对全身血压或氧饱和度的不良影响。
在 COPD 和 PH 患者中，吸入伊洛前列素是安全的，并且与改善的 V/Q 匹配和运动耐量相关。
