在海拔2850米的基多市，对患有肺血管疾病的患者进行超声心动图评估高剂量补充氧气对血流动力学的急性影响：一项随机、单盲、安慰剂对照的交叉试验。
The acute effect of high-dose supplemental oxygen on haemodynamics assessed by echocardiography in patients with pulmonary vascular disease living in Quito at 2850 m: a randomized, single-blind, placebo-controlled crossover trial.
作者信息
Müller Julian, Lichtblau Mona, Saxer Stéphanie, Schmucki Mirjam, Furian Michael, Schneider Simon R, Herzig Joël J, Bauer Meret, Saragoni Diego, Schwarz Esther I, Cajamarca Elizabeth, Hoyos Rodrigo, Ulrich Silvia
机构信息
Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8032 Zurich, Switzerland.
出版信息
Eur Heart J Open. 2024 Dec 2;4(6):oeae097. doi: 10.1093/ehjopen/oeae097. eCollection 2024 Nov.
AIMS
More than 220 Mio people live at altitudes above 2000 m, many of whom have pre-existing chronic diseases, including pulmonary vascular diseases (PVDs) such as pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH). We investigated the acute effects of high-dose supplemental oxygen on pulmonary haemodynamics assessed by echocardiography in patients with PVD permanently living at 2850 m.
METHODS AND RESULTS
In a randomized, single-blind, placebo-controlled crossover trial, patients with PVD diagnosed with PAH or CTEPH were allocated to receive 10 L/min supplemental oxygen (FiO ≈ 95%) and placebo air administered via a facial mask with reservoir near their living altitude in Quito at 2850 m (FiO0.21, PiO ≈ 60% of sea level) in random order with a washout period of >2 h. After >15 min of breathing the respective FiO, systolic pulmonary artery pressure (sPAP), cardiac output (CO), and other parameters were assessed by echocardiography. Furthermore, radial arterial blood gases were analysed. Twenty-eight patients with PVD (24 females, 26 PAH, age 45 ± 12 years) treated with phosphodiesterase-5 inhibitors ( = 28) and endothelin receptor antagonists ( = 9) were included. With oxygen vs. placebo air, sPAP was 57 ± 23 vs. 68 ± 24 mmHg, mean difference -11 mmHg (-15 to -6 mmHg, < 0.001), CO was 3.2 ± 0.9 vs. 3.9 ± 1.1 L/min; -0.7 L/min (-0.9 to -0.4 L/min, < 0.001), while sPAP/CO was unchanged, and the right ventriculo-arterial coupling was increased. PaO was 22.5 ± 9.7 vs. 7.6 ± 1.5 kPa; 14.9 kPa (11.4-18.4 kPa, < 0.001).
CONCLUSION
High-dose oxygen therapy in prevalent patients with PVD living near 2850 m significantly lowered sPAP but also CO by a reduced heart rate, resulting in an unchanged pulmonary resistance. Whether longer-term oxygen therapy would improve pulmonary vascular resistance requires further investigation.
REGISTRATION
NCT06084559 URL: https://clinicaltrials.gov/study/NCT06084559.
目的
超过2.2亿人生活在海拔2000米以上的地区，其中许多人患有慢性疾病，包括肺动脉高压（PAH）或慢性血栓栓塞性肺动脉高压（CTEPH）等肺血管疾病（PVD）。我们研究了高剂量补充氧气对永久居住在海拔2850米的PVD患者经超声心动图评估的肺血流动力学的急性影响。
方法和结果
在一项随机、单盲、安慰剂对照的交叉试验中，被诊断为PAH或CTEPH的PVD患者被分配接受10升/分钟的补充氧气（FiO₂≈95%）和通过带有储气袋的面罩在其居住海拔基多（2850米，FiO₂0.21，PiO₂≈海平面的60%）附近给予安慰剂空气，随机顺序给药，洗脱期>2小时。在呼吸各自的FiO₂超过15分钟后，通过超声心动图评估收缩期肺动脉压（sPAP）、心输出量（CO）和其他参数。此外，分析桡动脉血气。纳入了28例接受磷酸二酯酶-5抑制剂（n = 28）和内皮素受体拮抗剂（n = 9）治疗的PVD患者（24名女性，26例PAH，年龄45±12岁）。与安慰剂空气相比，吸氧时sPAP为57±23 mmHg，而安慰剂空气组为68±24 mmHg，平均差值为-11 mmHg（-15至-6 mmHg，P < 0.001），CO为3.2±0.9 L/min，而安慰剂空气组为3.9±1.1 L/min；差值为-0.7 L/min（-0.9至-0.4 L/min，P < 0.001），而sPAP/CO不变，右心室-动脉耦合增加。PaO₂为22.5±9.7 kPa，而安慰剂空气组为7.6±1.5 kPa；差值为14.9 kPa（11.4 - 18.4 kPa，P < 0.001）。
结论
在居住在海拔2850米附近的PVD患者中，高剂量氧疗显著降低了sPAP，但也通过降低心率使CO降低，导致肺阻力不变。长期氧疗是否会改善肺血管阻力需要进一步研究。
注册信息
NCT06084559 网址：https://clinicaltrials.gov/study/NCT06084559
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