Kanemoto N
Department of Internal Medicine, Tokai University School of Medicine, Isehara.
J Cardiol. 1988 Sep;18(3):757-63.
The present study was undertaken to clarify the natural history of primary pulmonary hypertension (PPH) from a hemodynamic point of view. The subjects consisted of 83 patients (18 men and 65 women), whose ages ranged from 14 to 69 years and averaged 33 years. They were contacted through a nationwide survey. All patients underwent right-sided cardiac catheterization; cardiac output was measured in 52 patients and pulmonary capillary wedge pressure, in 40 patients. The following results were obtained. 1. The patients who died within three months of their cardiac catheterization were in severe right ventricular failure as shown by their elevated right atrial pressures and decreased cardiac indices. 2. The patients who died suddenly within two years of their cardiac catheterization had the same degree of right ventricular failure. The only difference was severe hypoxia in the patients with cardiac failure (54 +/- 21 vs 66 +/- 4 mmHg, p less than 0.05). 3. The patients who survived more than two years had normal right ventricular function. 4. Among the hemodynamic variables used to estimate prognosis; namely, pulmonary artery diastolic pressure, pulmonary capillary wedge pressure, cardiac index, pulmonary vascular resistance and pulmonary to systemic vascular resistance ratio, the cardiac index was the best predictor of prognosis.
本研究旨在从血流动力学角度阐明原发性肺动脉高压（PPH）的自然病史。研究对象包括83例患者（18例男性和65例女性），年龄在14至69岁之间，平均年龄为33岁。他们是通过全国性调查联系到的。所有患者均接受了右心导管检查；52例患者测量了心输出量，40例患者测量了肺毛细血管楔压。获得了以下结果。1. 在心脏导管检查后三个月内死亡的患者存在严重的右心室衰竭，表现为右心房压力升高和心脏指数降低。2. 在心脏导管检查后两年内突然死亡的患者右心室衰竭程度相同。唯一的区别是心力衰竭患者存在严重缺氧（54±21 vs 66±4 mmHg，p<0.05）。3. 存活超过两年的患者右心室功能正常。4. 在用于评估预后的血流动力学变量中；即肺动脉舒张压、肺毛细血管楔压、心脏指数、肺血管阻力和肺与体循环血管阻力比值，心脏指数是预后的最佳预测指标。
