Pitton M B, Düber C, Mayer E, Thelen M
Department of Radiology, University Hospital, Johannes Gutenberg-University of Mainz, Germany.
Circulation. 1996 Nov 15;94(10):2485-91. doi: 10.1161/01.cir.94.10.2485.
Pulmonary angiography is the gold standard for the diagnosis of chronic thromboembolic pulmonary hypertension; however, major complications have been reported. This study evaluates the hemodynamic effects of direct pulmonary nonionic contrast bolus injection and oxygen inhalation in patients with chronic thromboembolic pulmonary hypertension.
In 33 patients, hemodynamic parameters were measured after oxygen inhalation and during bolus injection of nonionic contrast medium in a control group (group 1. n = 11), in a group of patients with moderately severe pulmonary hypertension (group 2, n = 9), and in a group with severe pulmonary hypertension (group 3, n = 13). Oxygen inhalation significantly improved oxygen supply. Pulmonary artery pressure and heart rate were reduced, but pulmonary vascular resistance and total pulmonary resistance were not significantly affected. One hundred ninety-eight angiograms were performed selectively on both pulmonary arteries in the posterior-anterior, oblique, and lateral views. Before contrast bolus injection, RAP and PAP significantly increased because of initial inspiration. Contrast bolus injection caused only a minor pressure increase (delta PA systolic, 2.3 +/- 1.4, 2.5 +/- 1.8, and 5.0 +/- 5.2 mm Hg, groups 1, 2, and 3, respectively) without significance between the groups. After the angiography, pulmonary artery pressure was moderately increased, predominantly in group 3, but pulmonary vascular resistance was not significantly changed. Systemic vascular resistance was decreased. Cardiac index increased in groups 1 and 2 but was unchanged in group 3. Systemic pressure therefore decreased in group 3.
We concluded that bolus injection of nonionic contrast medium causes no major hemodynamic effects even in patients with severe chronic thromboembolic pulmonary hypertension. Oxygen contributes to safety during the procedure.
肺血管造影是诊断慢性血栓栓塞性肺动脉高压的金标准；然而，有报道称其存在严重并发症。本研究评估了直接经肺动脉推注非离子型造影剂和吸氧对慢性血栓栓塞性肺动脉高压患者血流动力学的影响。
在33例患者中，测量了吸氧后及在对照组（1组，n = 11）、中度严重肺动脉高压组（2组，n = 9）和重度肺动脉高压组（3组，n = 13）推注非离子型造影剂期间的血流动力学参数。吸氧显著改善了氧供。肺动脉压和心率降低，但肺血管阻力和总肺阻力未受到显著影响。对双侧肺动脉进行了198次选择性血管造影，投照体位包括前后位、斜位和侧位。在推注造影剂前，由于初始吸气，右房压和肺动脉压显著升高。推注造影剂仅引起轻微的压力升高（1组、2组和3组的肺动脉收缩压增量分别为2.3±1.4、2.5±1.8和5.0±5.2 mmHg），组间无显著性差异。血管造影后，肺动脉压适度升高，主要发生在3组，但肺血管阻力无显著变化。体循环血管阻力降低。1组和2组的心指数增加，但3组无变化。因此，3组的体循环压力降低。
我们得出结论，即使是重度慢性血栓栓塞性肺动脉高压患者，推注非离子型造影剂也不会引起重大血流动力学影响。吸氧有助于操作过程中的安全性。
