Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
Medical University of South Carolina, Charleston, SC, 29425, USA.
Best Pract Res Clin Anaesthesiol. 2018 Jun;32(2):237-250. doi: 10.1016/j.bpa.2018.06.006. Epub 2018 Jul 3.
Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. The present investigation describes new pulmonary vasodilator agents that are currently available or under development that could impact perioperative management. The 6-min walk test is the gold standard in assessing the efficacy of any pulmonary hypertension treatment, and the only drug to show any mortality benefit in pulmonary hypertension is epoprostenol. The present investigation also describes the latest evidence on using these medications in the perioperative period, including clinical trials and practice guidelines. Future direction for research and clinical management of pulmonary hypertension is described.
许多疾病都会导致肺动脉高压(PAH),其中大多数是特发性的。最初,其症状和体征通常很难识别,因为它们表现为非特异性,并且通常被误认为与年龄相关的生理过程或其他医疗状况。针对 PAH 的特异性治疗已经取得了许多进展,这使得疾病的临床管理得到了进一步发展。本研究介绍了目前可用于或正在开发的新型肺血管扩张剂,它们可能会影响围手术期管理。6 分钟步行试验是评估任何肺动脉高压治疗效果的金标准,唯一显示对肺动脉高压有任何生存获益的药物是依前列醇。本研究还描述了这些药物在围手术期的最新使用证据,包括临床试验和实践指南。描述了肺动脉高压的研究和临床管理的未来方向。