Follath F
Schweiz Med Wochenschr. 1985 Sep 28;115(39):1328-32.
Drugs with pharmacological activity limited to the pulmonary circulation are not at present available. Serotonin antagonists, specific thromboxane A2 inhibitors and prostacyclin may offer new possibilities for the treatment of certain forms of pulmonary arterial hypertension (PAH), but their clinical efficacy remains to be evaluated. Vasodilators simultaneously influence the pulmonary and systemic vascular resistances, and their overall hemodynamic effects in patients with PAH are therefore unpredictable. Therapeutic trials with such drugs should be closely monitored to avoid serious adverse reactions. Oral administration of beta-adrenergic agents, such as salbutamol or terbutaline, is preferable to digoxin in the treatment of patients with right ventricular failure due to chronic obstructive bronchitis. Right ventricular failure following massive pulmonary embolism may be aggravated by reduced blood flow through the right coronary artery. Increase of aortic perfusion pressure (e.g. noradrenaline) should be considered as a therapeutic measure in patients with arterial hypotension.
目前尚无药理活性仅限于肺循环的药物。5-羟色胺拮抗剂、特异性血栓素A2抑制剂和前列环素可能为某些类型的肺动脉高压（PAH）治疗提供新的可能性，但其临床疗效仍有待评估。血管扩张剂会同时影响肺血管阻力和体循环血管阻力，因此它们对PAH患者的整体血液动力学影响是不可预测的。对此类药物进行治疗试验时应密切监测，以避免严重不良反应。在治疗因慢性阻塞性支气管炎导致右心室衰竭的患者时，口服β-肾上腺素能药物（如沙丁胺醇或特布他林）比地高辛更可取。大面积肺栓塞后的右心室衰竭可能因右冠状动脉血流减少而加重。对于动脉低血压患者，应考虑提高主动脉灌注压（如去甲肾上腺素）作为一种治疗措施。
