Olschewski H, Ghofrani H A, Walmrath D, Temmesfeld-Wollbrück B, Grimminger F, Seeger W
Department of Internal Medicine II, Justus-Liebig-University, Giessen, Germany.
Intensive Care Med. 1998 Jun;24(6):631-4. doi: 10.1007/s001340050628.
The treatment of decompensated right ventricular failure with vasodilators is difficult due to reduced systemic pressure and/or ventilation/perfusion (V/Q) mismatch with hypoxemia. In a recent study we demonstrated that inhaled vasodilatory prostanoids may offer a new strategy to achieve pulmonary selective vasodilatation and improvement of right ventricular function. We applied this new approach to a patient with circulatory shock due to primary pulmonary hypertension (PPH), complicated by a pulmonary infiltrate, who did not tolerate intravenous prostacyclin.
Case report.
Intensive Care Unit (ICU), Medizinische Klinik Giessen, Germany.
A 45-year-old woman with PPH presenting with decompensated right heart failure (ascites, pleural effusion), circulatory shock and commencing renal and hepatic failure, despite maximum therapy including the use of catecholamines.
Intermittent inhalation of aerosolized iloprost, the stable analogue of prostacyclin, and comparison to inhaled nitric oxide (NO). Subsequent long-term therapy with aerosolized iloprost, 150 microg/day.
In response to inhaled iloprost, pulmonary arterial pressure (PAP) decreased from 65 to 61 mmHg, cardiac index (CI) increased from 1.25 to 1.85 l/min per m2, and pulmonary vascular resistance (PVR) decreased from 2416 to 1549 dyn/s per cm5 while inhaled NO decreased the PVR from 2280 to 1920 dyn/s per cm5 without a decrease in PAP. Both of these interventions increased the arterial pO2 but did not change the systemic arterial pressure. In contrast, intravenous prostacyclin was not tolerated, due to systemic side effects. During repeated inhalations with iloprost, the baseline hemodynamics and gas exchange improved dramatically and renal and liver functions normalized. During 1 year of continued therapy, the clinical status improved very much, concomitant with improved hemodynamics, and the patient has been taken off the transplantation list.
Inhalation of aerosolized iloprost may offer a new life-saving strategy in near desperate cases of pulmonary hypertension in which intravenous prostacyclin cannot be applied due to severe side effects.
由于体循环压力降低和/或存在通气/灌注（V/Q）不匹配并伴有低氧血症，使用血管扩张剂治疗失代偿性右心室衰竭存在困难。在最近的一项研究中，我们证明吸入性血管扩张性前列腺素可能提供一种新的策略，以实现肺血管选择性扩张并改善右心室功能。我们将这种新方法应用于一名因原发性肺动脉高压（PPH）导致循环性休克且合并肺部浸润、无法耐受静脉注射前列环素的患者。
病例报告。
德国吉森医学诊所重症监护病房（ICU）。
一名45岁患有PPH的女性，出现失代偿性右心衰竭（腹水、胸腔积液）、循环性休克，并开始出现肾和肝功能衰竭，尽管接受了包括使用儿茶酚胺在内的最大程度治疗。
间歇性吸入雾化伊洛前列素（前列环素的稳定类似物），并与吸入一氧化氮（NO）进行比较。随后长期使用雾化伊洛前列素治疗，每日150微克。
吸入伊洛前列素后，肺动脉压（PAP）从65 mmHg降至61 mmHg，心脏指数（CI）从1.25升/分钟每平方米增至1.85升/分钟每平方米，肺血管阻力（PVR）从2416达因/秒每平方厘米降至1549达因/秒每平方厘米，而吸入NO使PVR从2280达因/秒每平方厘米降至1920达因/秒每平方厘米，但PAP未降低。这两种干预措施均使动脉血氧分压升高，但未改变体循环动脉压。相比之下，由于全身副作用，患者无法耐受静脉注射前列环素。在反复吸入伊洛前列素期间，基线血流动力学和气体交换显著改善，肾和肝功能恢复正常。在持续治疗的1年中，临床状况大为改善，同时血流动力学也有所改善，该患者已被从移植名单中除名。
对于因严重副作用而无法应用静脉注射前列环素的肺动脉高压危重症病例，吸入雾化伊洛前列素可能提供一种新的挽救生命的策略。
