Vorhies Erika E, Caruthers Regine L, Rosenberg Howard, Yu Sunkyung, Gajarski Robert J
Division of Pediatric Cardiology, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada,
Pediatr Cardiol. 2014 Dec;35(8):1337-43. doi: 10.1007/s00246-014-0933-3. Epub 2014 May 29.
Inhaled nitric oxide (iNO) is considered standard therapy for pediatric postcardiac surgical pulmonary hypertension (PH). Limited data suggest that inhaled iloprost (inIlo), an aerosolized prostacyclin, may be a feasible and more affordable therapeutic alternative. The goal of this study was to determine if significant hemodynamic change or adverse events would occur in postoperative congenital heart surgery (CHS) patients with PH after their transition from iNO to inIlo. This retrospective review investigated CHS patients with postoperative PH (mean pulmonary artery pressure [mPAP] >25 mmHg) between January 1, 2010 and December 31, 2011 who transitioned from iNO to inIlo. By protocol, CHS patients receiving stable doses of iNO were gradually transitioned to inIlo. After full transition, the patients received inIlo every 2 h, with a final dosing range of 1.25-5 μg/dose. Both PAP and systemic arterial pressure (SAP) were invasively measured during the transition period. Seven patients ages 10 days to 1.5 years completed the protocol. Measurements of mPAP (p = 0.27) and systolic PAP (p = 0.25) did not differ between iNO and inIlo therapy alone. No serious adverse events or complications (bleeding or thrombocytopenia) occurred. The ratio of systolic PAP to SAP decreased in all patients receiving inIlo alone (p = 0.03). Pulmonary hypertension in postoperative CHS patients can be managed successfully with inIlo, and the measured hemodynamics with this agent are similar to those observed with iNO. For the management of postoperative PH, inIlo may be a reasonable alternative, thus reducing the need for costly iNO. Larger confirmatory studies would more robustly facilitate its integration into standard care.
吸入一氧化氮（iNO）被认为是小儿心脏手术后肺动脉高压（PH）的标准治疗方法。有限的数据表明，吸入伊洛前列素（inIlo），一种雾化的前列环素，可能是一种可行且更经济的治疗选择。本研究的目的是确定先天性心脏病手术（CHS）后患有PH的患者从iNO转换为inIlo后是否会发生显著的血流动力学变化或不良事件。这项回顾性研究调查了2010年1月1日至2011年12月31日期间从iNO转换为inIlo的术后PH（平均肺动脉压[mPAP]>25 mmHg）的CHS患者。按照方案，接受稳定剂量iNO的CHS患者逐渐转换为inIlo。完全转换后，患者每2小时接受一次inIlo，最终给药范围为1.25 - 5μg/剂量。在转换期间通过侵入性测量肺动脉压（PAP）和体动脉压（SAP）。7名年龄在10天至1.5岁的患者完成了该方案。单独使用iNO和inIlo治疗时，mPAP（p = 0.27）和收缩期PAP（p = 0.25）的测量值没有差异。未发生严重不良事件或并发症（出血或血小板减少）。仅接受inIlo治疗的所有患者中，收缩期PAP与SAP的比值下降（p = 0.03）。术后CHS患者中的肺动脉高压可以用inIlo成功管理，并且使用该药物测量的血流动力学与使用iNO观察到的相似。对于术后PH的管理，inIlo可能是一种合理的替代方案，从而减少对昂贵的iNO的需求。更大规模的验证性研究将更有力地促进其纳入标准治疗。
