Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
J Card Fail. 2011 Oct;17(10):813-8. doi: 10.1016/j.cardfail.2011.05.012. Epub 2011 Jul 8.
Pulmonary hypertension (PH) can lead to right-side heart failure (RHF) and death. There are no therapeutic recommendations for patients experiencing acute RHF in the course of PH. This study aimed to examine the safety and efficacy of inhaled iloprost in patients with precapillary PH and RHF.
Between October 2007 and December 2008, 7 patients with precapillary PH and RHF were enrolled. Per protocol, iloprost was inhaled hourly for a minimum of 12 hours during a 24-hour period. The starting dose of 2.5 μg was increased hourly by 2.5 μg as long as the increases were tolerated. Safety and efficacy were determined by continuous invasive monitoring of systemic and pulmonary hemodynamic parameters. Systemic pressures remained stable during inhalation (66.1 ± 6.9 mm Hg at baseline and 69.1 ± 6.4 mm Hg immediately after inhalation therapy, P = 0.48). Cardiac index increased from 2.4 ± 0.7 L/min/m(2) to 2.9 ± 0.9 L/min/m(2) (P = .008). Pulmonary vascular resistance decreased from 634.6 ± 218.3 dyn·s·cm(-5) to 489.6 ± 173.8 dyn·s·cm(-5) (P = .044), and N-terminal B-type natriuretic peptide levels decreased from 13,591 ± 10,939 pg/mL to 9,944 ± 8,569 pg/mL (P = .051).
Blood pressure-guided hourly inhalation of iloprost may offer a safe and effective strategy for the treatment of PH patients with RHF.
肺动脉高压（PH）可导致右心衰竭（RHF）和死亡。对于 PH 过程中出现急性 RHF 的患者，目前尚无治疗建议。本研究旨在研究吸入伊洛前列素治疗毛细血管前 PH 和 RHF 患者的安全性和疗效。
2007 年 10 月至 2008 年 12 月，共纳入 7 例毛细血管前 PH 和 RHF 患者。根据方案，伊洛前列素以 2.5 μg/小时的起始剂量吸入，至少 12 小时，24 小时内每小时增加 2.5 μg，只要能够耐受增加的剂量。通过连续监测系统和肺血流动力学参数来确定安全性和疗效。吸入期间全身血压保持稳定（吸入前为 66.1 ± 6.9 mm Hg，吸入后即刻为 69.1 ± 6.4 mm Hg，P =.48）。心指数从 2.4 ± 0.7 L/min/m2增加至 2.9 ± 0.9 L/min/m2（P =.008）。肺血管阻力从 634.6 ± 218.3 dyn·s·cm-5降低至 489.6 ± 173.8 dyn·s·cm-5（P =.044），N 端 B 型利钠肽水平从 13,591 ± 10,939 pg/ml 降低至 9,944 ± 8,569 pg/ml（P =.051）。
基于血压的伊洛前列素每小时吸入可能为 PH 合并 RHF 患者的治疗提供一种安全有效的策略。
