[吸入伊洛前列素对慢性血栓栓塞性肺动脉高压患者血流动力学和氧合的急性影响]

[The acute effects of inhaled iloprost on hemodynamics and oxygenation in chronic thromboembolic pulmonary hypertension].

作者信息

Luo Ling, Yang Yuan-Hua, Cui Na, Xie Wan-Mu, Zhai Zhen-Guo, Ma Zhan-Hong, Wang Chen

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Diseases, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Aug 11;89(30):2103-5.

PMID:20058612

Abstract

OBJECTIVE

To evaluate the acute effects of inhaled iloprost on hemodynamics and oxygenation in chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS

A prospective study was made. Eighteen patients with CTEPH were enrolled. At right heart catheterisation, iloprost was inhaled at 20 microg for 10 - 15 min. Compare the value of heart rate (HR), mean blood pressure (mBP), mean pulmonary arterial hypertension (mPAP), right atrium pressure (RAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), mixed venous saturation (SvO2), pulmonary shunt fraction (Qs/Qt), alveolar-arterial partial pressure of oxygen [P ( A-a) O2] before to after inhaled iloprost in these patients.

RESULTS

Significant changes (before to after inhalation): mPAP, (53 +/- 11) to (47 +/- 14) mm Hg (P < 0.01); PVR, (821 +/- 194) to (681 +/- 199) dyn x s x cm(-5) (P < 0.01); RAP, (10 +/- 6) to (7 +/- 6) mm Hg (P < 0.01). However, HR, PAWP, mBP, CO and SVR had no significant changes. At the same time, inhaled iloprost significantly decreased PaO2 from (58 +/- 11) to (52 +/- 6) mm Hg (P < 0.01) and increased Qs/Qt from (27 +/- 11)% to (33 +/- 9)% (P < 0.01)and P(A-a) O2 from (86 +/-39) to (93 +/- 38) mm Hg (P < 0.01).

CONCLUSION

Inhaled iloprost might instantly improve hemodynamics in CTEPH, but at the same time it increased arteriovenous shunts which resulted in lower PaO2.

摘要

目的

评估吸入伊洛前列素对慢性血栓栓塞性肺动脉高压（CTEPH）患者血流动力学和氧合的急性影响。

方法

进行一项前瞻性研究。纳入18例CTEPH患者。在右心导管检查时，吸入20微克伊洛前列素，持续10 - 15分钟。比较这些患者吸入伊洛前列素前后心率（HR）、平均血压（mBP）、平均肺动脉压（mPAP）、右心房压（RAP）、肺动脉楔压（PAWP）、心输出量（CO）、肺血管阻力（PVR）、体循环血管阻力（SVR）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、混合静脉血氧饱和度（SvO2）、肺分流分数（Qs/Qt）、肺泡 - 动脉血氧分压差[P（A - a）O2]的值。

结果

（吸入前后的）显著变化：mPAP，从（53±11）降至（47±14）毫米汞柱（P < 0.01）；PVR，从（821±194）降至（681±199）达因·秒·厘米⁻⁵（P < 0.01）；RAP，从（10±6）降至（7±6）毫米汞柱（P < 0.01）。然而，HR、PAWP、mBP、CO和SVR无显著变化。同时，吸入伊洛前列素使PaO2从（58±11）显著降至（52±6）毫米汞柱（P < 0.01），使Qs/Qt从（27±11）%增至（33±9）%（P < 0.01），使P（A - a）O2从（86±39）增至（93±38）毫米汞柱（P < 0.01）。