Okazaki Hirotake, Hata Noritake, Shirakabe Akihiro, Tsurumi Masafumi, Shinada Takuro, Shimizu Wataru
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital.
J Nippon Med Sch. 2015;82(4):206-10. doi: 10.1272/jnms.82.206.
A 70-year-old woman who had been treated for bipolar disorder and dementia was admitted to the intensive care unit of a university hospital with severe dyspnea; pulmonary arterial hypertension was diagnosed after cardiac catheterization was performed. Computed tomography pulmonary angiography showed typical signs of chronic thrombosis in the proximal pulmonary artery without an adequate amount of fresh thrombi, which appeared to be the cause of the elevation in pulmonary artery pressure, and resulted in severe hypoxemia. Therefore, the pulmonary arterial hypertension was classified as belonging to the chronic thromboembolic pulmonary hypertension subgroup. Although the patient's respiratory condition was classified as World Health Organization class IV, she was treated with the combination of oral ambrisentan and tadalafil, rather than intravenous epoprostenol, which she was unable to tolerate. Consequently, both her symptom and hemodynamic status showed rapid improvement with only oral pulmonary vasodilators. This case demonstrates the efficacy of oral treatment alone in elderly patients with severe chronic thromboembolic pulmonary hypertension.
一名曾接受双相情感障碍和痴呆症治疗的70岁女性因严重呼吸困难入住大学医院重症监护病房；心脏导管检查后诊断为肺动脉高压。计算机断层扫描肺动脉造影显示近端肺动脉有典型的慢性血栓迹象，但新鲜血栓量不足，这似乎是肺动脉压力升高的原因，并导致严重低氧血症。因此，该肺动脉高压被归类为慢性血栓栓塞性肺动脉高压亚组。尽管患者的呼吸状况被归类为世界卫生组织IV级，但她接受了口服安立生坦和他达拉非的联合治疗，而不是她无法耐受的静脉注射依前列醇。结果，仅使用口服肺血管扩张剂，她的症状和血流动力学状态都迅速改善。该病例证明了单纯口服治疗对老年重度慢性血栓栓塞性肺动脉高压患者的疗效。
