Ford W D, Sen S, Barker A P, Lee C M
Department of Paediatric Surgery, Adelaide Children's Hospital, Australia.
J Pediatr Surg. 1990 May;25(5):487-91. doi: 10.1016/0022-3468(90)90556-o.
After antenatal induction of diaphragmatic hernias in fetal lambs, prostaglandins D2, E1, and I2 were compared to tolazoline, or isoprenaline, for the treatment of pulmonary hypertension. When rendered hypoxic, these, and normal lambs, showed an increase in pulmonary artery pressure, a decrease in systemic pressure, and a decrease in pulmonary blood flow. All of the drugs altered that response, but to different degrees. None of the drugs tested was consistently successful in reversing the adverse affects of hypoxia, but prostaglandin D2 came closest to the ideal vasodilator, decreasing the pulmonary artery pressure in all seven hypoxic lambs having a diaphragmatic hernia. There was a concomitant increase in pulmonary blood flow in six; in the remaining lamb the decrease in blood flow induced by the hypoxia was arrested. At the same time, there was an increase in systemic artery pressure in three, the decrease was arrested in two, but the decrease continued in the other two. Isoprenaline was a more effective drug than tolazoline, producing an increase in pulmonary blood flow in five of the seven lambs, with minor decreases in systemic pressure in five. Tolazoline improved blood flow in three of six lambs (not all lambs survived the full study), with a marked decrease in systemic pressure in four of them. Prostaglandin D2 seems to be a useful drug for the treatment of patients having diaphragmatic hernias and pulmonary hypertension, and warrants further study. Isoprenaline was the most effective of the readily available drugs tested in this animal model.
在对胎羊进行产前膈疝诱导后，将前列腺素D2、E1和I2与妥拉唑啉或异丙肾上腺素用于治疗肺动脉高压进行比较。当这些胎羊以及正常胎羊处于缺氧状态时，肺动脉压升高，体循环压力降低，肺血流量减少。所有药物都改变了这种反应，但程度不同。所测试的药物均未能始终如一地成功逆转缺氧的不利影响，但前列腺素D2最接近理想的血管扩张剂，在所有7只患有膈疝的缺氧胎羊中均降低了肺动脉压。6只胎羊的肺血流量随之增加；在其余1只胎羊中，缺氧引起的血流量减少得到了遏制。与此同时，3只胎羊的体循环动脉压升高，2只胎羊的血压下降得到了遏制，但另外2只胎羊的血压仍在下降。异丙肾上腺素比妥拉唑啉更有效，7只胎羊中有5只的肺血流量增加，5只胎羊的体循环压力略有下降。妥拉唑啉使6只胎羊中的3只血流量增加（并非所有胎羊都存活至整个研究结束），其中4只胎羊的体循环压力显著下降。前列腺素D2似乎是治疗患有膈疝和肺动脉高压患者的一种有用药物，值得进一步研究。在该动物模型中，异丙肾上腺素是所测试的易于获得的药物中最有效的。
