Davidson A, Bossuyt A, Dab I
Academic Hospital, Free University of Brussels, Belgium.
Pediatr Pulmonol. 1989;6(1):53-9. doi: 10.1002/ppul.1950060113.
The acute effects of oxygen, nifedipine, and diltiazem were studied in eight patients with cystic fibrosis and mild pulmonary hypertension, to assess the possibility of relieving the latter before the occurrence of irreversible vascular changes. Oxygen decreased pulmonary pressure (-23%) and resistance (-21%), while increasing systemic resistance (+23%). Nifedipine increased cardiac index (+30%), at the expense of augmented right ventricular work (+42%), resulting in a decreased calculated pulmonary resistance (-23%); pulmonary artery pressure remained unchanged, however. Nifedipine decreased arterial Po2 (-10%), suggesting ventilation-perfusion mismatch. Four of the eight patients responded to diltiazem. Their pulmonary pressure (-35%) and resistance (-43%) decreased, while systemic vascular tone remained unchanged. Oxygen in three patients, and diltiazem in two, returned pulmonary pressures and resistances to normal values. Early reversal of pulmonary hypertension is possible, and intervention is desirable before the establishment of chronic hypoxia, cor pulmonale, or right ventricular failure. Our data does not support the use of nifedipine in pulmonary hypertension, but shows that oxygen, and in some cases diltiazem, act as effective and selective pulmonary vasodilators.
对8例囊性纤维化合并轻度肺动脉高压患者研究了氧气、硝苯地平和地尔硫䓬的急性效应，以评估在不可逆血管改变发生前缓解肺动脉高压的可能性。氧气可降低肺动脉压（-23%）和肺血管阻力（-21%），同时增加体循环阻力（+23%）。硝苯地平可增加心指数（+30%），代价是右心室作功增加（+42%），导致计算出的肺血管阻力降低（-23%）；然而肺动脉压保持不变。硝苯地平降低动脉血氧分压（-10%），提示通气-灌注不匹配。8例患者中有4例对地尔硫䓬有反应。他们的肺动脉压（-35%）和肺血管阻力（-43%）降低，而体循环血管张力保持不变。3例患者吸氧以及2例患者用地尔硫䓬后，肺动脉压和肺血管阻力恢复到正常水平。肺动脉高压早期逆转是可能的，在慢性缺氧、肺心病或右心室衰竭确立之前进行干预是可取的。我们的数据不支持在肺动脉高压中使用硝苯地平，但表明氧气以及在某些情况下地尔硫䓬可作为有效的选择性肺血管扩张剂。
