CAJ | 학술논문

目的评价雾化吸入伊洛前列素对重度成人先天性心脏病相关性肺动脉高压血液动力学的影响.方法对165例经超声心动图诊断先天性心脏病合并重度肺动脉高压患者进行左右心导管检查获得基线血液动力学参数后雾化吸入伊洛前列素20 μg,10 min时再记录相关血液动力学资料,对比吸入伊诺前列素前后血液动力学的变化.结果伊洛前列素吸入结束后即刻和吸入前比较,患者主动脉和肺动脉的压力略有下降(P＜0.05),但心率、主动脉平均压、肺动脉收缩压与主动脉收缩压的比值(Pp/Ps)差异均无统计学意义(P＞0.05).肺循环血量(Qp)明显增加[(7.2±4.8)L/min比(9.9±7.2)L/min,P＜0.01],肺血管阻力(PVR)明显下降[(13.4±8.7)Wood单位比(9.5±6.6)Wood单位,P＜0.01],左向右分流量明显增加[(3.2±4.4)L/min比(5.5±7.0)L/min,P＜0.01]及右向左分流量明显减少[(1.0±1. 0)L/min比(0.7±0.7)L/min,P＜0.01].亚组分析结果提示,不是所有先天性心脏病合并重度肺动脉高压患者血液动力学均呈相同的变换趋势,存在动脉导管未闭和(或)心室间隔缺损患者的肺动脉压力明显高于继发于心房间隔缺损患者,而且更易出现艾森曼格综合征(P＜0.05).结论伊洛前列素雾化吸入可快速降低先天性心脏病相关性肺动脉高压的压力、肺血管阻力,明显增加右心排血量,对体循环压力及心率影响较小,可以作为评估急性肺血管反应的肺血管扩张剂.
목적 평개무화흡입이락전렬소대중도성인선천성심장병상관성폐동맥고압혈액동역학적영향.방법 대165례경초성심동도진단선천성심장병합병중도폐동맥고압환자진행좌우심도관검사획득기선혈액동역학삼수후무화흡입이락전렬소20 μg,10 min시재기록상관혈액동역학자료,대비흡입이낙전렬소전후혈액동역학적변화.결과 이락전렬소흡입결속후즉각화흡입전비교,환자주동맥화폐동맥적압력략유하강(P＜0.05),단심솔、주동맥평균압、폐동맥수축압여주동맥수축압적비치(Pp/Ps)차이균무통계학의의(P＞0.05).폐순배혈량(Qp)명현증가[(7.2±4.8)L/min비(9.9±7.2)L/min,P＜0.01],폐혈관조력(PVR)명현하강[(13.4±8.7)Wood단위비(9.5±6.6)Wood단위,P＜0.01],좌향우분류량명현증가[(3.2±4.4)L/min비(5.5±7.0)L/min,P＜0.01]급우향좌분류량명현감소[(1.0±1. 0)L/min비(0.7±0.7)L/min,P＜0.01].아조분석결과제시,불시소유선천성심장병합병중도폐동맥고압환자혈액동역학균정상동적변환추세,존재동맥도관미폐화(혹)심실간격결손환자적폐동맥압력명현고우계발우심방간격결손환자,이차경역출현애삼만격종합정(P＜0.05).결론 이락전렬소무화흡입가쾌속강저선천성심장병상관성폐동맥고압적압력、폐혈관조력,명현증가우심배혈량,대체순배압력급심솔영향교소,가이작위평고급성폐혈관반응적폐혈관확장제.
Objective To investigate the immediately effects of inhaled aerosolized iloprost in adult patients with severe pulmonary arterial hypertension(PAH)secondary to congenital heart diseases(CHD).Methods Adult patients with severe PAH secondary to CHD(n = 165)were included in this study. Right heart catheterization was performed, Pulmonary and systemic blood flow, the oxygen consumption VO2(ml/min)were calculated using Fick's principle. Pulmonary vascular resistances(PVR)were calculated with standard formulas and indexed to body surface area. Hemodynamic parameters were measured before and after iloprost inhalation(20 μg). Results Post iloprost inhalation, heart rate, mean aortic pressure, pulmonary systolic pressure to aortic systolic pressure ratio all remained unchanged(P ＞ 0. 05), while pulmonary artery pressure(PAP)were significantly reduced and Qp significantly increased from(7. 2 ±4. 8)L/min to(9. 9 ±7.2)L/min(P＜0.01), PVR was also significantly reduced from(13.4 ±8.7)Wood units to(9.5 ±6. 6)Wood units(P ＜0. 01),and left-to-right shunt volume increased from(3.2 ±4. 4)L/min to(5. 5 ±7.0)L/min(P ＜ 0. 01)and right -to-left shunt volume decreased from(1.0 ± 1.0)L/min to(0. 7 ± 0. 7)L/min(P ＜ 0. 01). Subgroup analysis showed that adult patients with patent ductus arteriosus and/or ventricular septal defects are more likely to develop severe pulmonary arterial hypertension or Eisenmenger syndrome than patients with atrial septal defects. Conclusions Inhaled Aerosolised iloprost use is effective and safe for adult patients with severe pulmonary arterial hypertension secondary to congenital heart diseases.