Department of Pediatrics, Universidad Nacional de Colombia, Fundación Santa Fe de Bogotá, Bogotá Colombia.
Clínica De La Mujer, Centro Policlínico del Olaya, Bogotá, Colombia.
High Alt Med Biol. 2021 Dec;22(4):395-405. doi: 10.1089/ham.2021.0026.
Diaz, Gabriel F., Alicia Marquez, Ariel Ruiz-Parra, Maurice Beghetti, and Dunbar Ivy. An acute hyperoxia test predicts survival in children with pulmonary hypertension living at high altitude. . 22:395-405, 2021. Pulmonary hypertension (PH) causes significant morbidity and mortality in children at altitude. Fifty-two children living at 2,640 m were included. During hyperoxia test (OTest), patients received high oxygen concentrations (FiO >80, through Mask, using Venturi or nonrebreathing mask); echocardiography was used to evaluate pulmonary vasculature reactivity. A decrease >20% from the basal pulmonary artery systolic pressure was considered a positive response. Most of the patients had severe PH. The median age at diagnosis was 4.5 years; 34 were female (65.4%). Idiopathic PH was present in 44 patients (84.6%). Six developed severe PH after ductus closure. They were classified in responders ( = 25), and nonresponders ( = 26). Responders were younger (3 years vs. 7 years, = 0.02), and 22 (88%), had better functional class (FC) 1-2, than nonresponders: 18 (69.23%) of them had worse FC: 3-4 ( = 0.000). In responders, 10/12 who went to live at low altitude became asymptomatic, compared with 7/13 who remained at high altitude. FC 1-2 was achieved by 70% of the patients with idiopathic PH who went to a low altitude, compared with 30% who continued at high altitude ( = 0.03). In nonresponders, 10/26 patients moved to a low altitude: four improved, one worsened, and five died; of the 16/26 patients living at high altitude, four are stable, eight worsened, and four died. Four patients (30.76%) in responder group and nine (69.24%) in the nonresponder group died ( = 0.03). There were differences between both groups in systolic (88 mm Hg vs. 110 mm Hg; = 0.037), diastolic (37 mm Hg vs. 56 mm Hg; = 0.035), and mean pulmonary artery pressures (57 mm Hg vs. 88 mm Hg; = 0.038). This specific hyperoxia test applied until 24 hours (not published before) helps to predict survival and prognosis of children with PH. Children with PH at a high altitude improve at low altitude.
迪亚兹、加布里埃尔·F.、艾丽西亚·马尔克斯、阿里尔·鲁伊斯-帕拉、莫里斯·贝赫蒂和邓巴·艾维。急性高氧试验预测生活在高海拔地区的肺动脉高压儿童的生存。 22:395-405, 2021. 肺动脉高压（PH）在高海拔地区的儿童中会导致严重的发病率和死亡率。 共纳入 52 名生活在 2640 米处的儿童。在高氧试验（OTest）中，患者接受高氧浓度（FiO >80，通过面罩，使用文丘里或无重复呼吸面罩）；超声心动图用于评估肺血管反应性。从基础肺动脉收缩压下降 >20%被认为是阳性反应。 大多数患者有严重的 PH。中位诊断年龄为 4.5 岁；34 名女性（65.4%）。44 例为特发性 PH（84.6%）。6 例在动脉导管关闭后发生严重 PH。他们被分为应答者（ = 25）和无应答者（ = 26）。应答者更年轻（3 岁比 7 岁， = 0.02），且 22 名（88%）的功能分级（FC）为 1-2，比无应答者更好：18 名（69.23%）为 FC：3-4（ = 0.000）。在应答者中，12 名中有 10 名（83.33%）前往低海拔地区后无症状，而 13 名中只有 7 名（53.85%）留在高海拔地区（ = 0.000）。前往低海拔地区的特发性 PH 患者中有 70%达到 FC 1-2，而继续留在高海拔地区的患者中只有 30%达到 FC 1-2（ = 0.03）。在无应答者中，26 名中有 10 名（38.46%）前往低海拔地区：4 名改善，1 名恶化，5 名死亡；26 名中仍留在高海拔地区的有 16 名（61.54%）：4 名稳定，8 名恶化，4 名死亡。应答组中有 4 名（30.76%）和无应答组中有 9 名（69.24%）患者死亡（ = 0.03）。两组之间在收缩压（88 mm Hg 与 110 mm Hg； = 0.037）、舒张压（37 mm Hg 与 56 mm Hg； = 0.035）和平均肺动脉压（57 mm Hg 与 88 mm Hg； = 0.038）方面存在差异。 这种特定的高氧试验直到 24 小时（以前未发表过），有助于预测 PH 儿童的生存和预后。生活在高海拔地区的 PH 儿童在低海拔地区会得到改善。
