中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
9期
765-768
,共4页
宁宁%王岚%张宏达%刘倩倩%彭富华%赵勤华%蒋鑫%何晶%姜蓉
寧寧%王嵐%張宏達%劉倩倩%彭富華%趙勤華%蔣鑫%何晶%薑蓉
저저%왕람%장굉체%류천천%팽부화%조근화%장흠%하정%강용
高血压,肺性%伊洛前列素
高血壓,肺性%伊洛前列素
고혈압,폐성%이락전렬소
Hypertension,pulmonary%Iloprost
目的 观察以吸入伊洛前列素为基础的联合治疗策略对合并严重右心衰竭肺高血压患者的效果及安全性.方法 入选201 1年1月至2013年1月于同济大学附属上海市肺科医院住院治疗的世界卫生组织(WHO)肺高血压功能分级为Ⅳ级的第一大类肺高血压患者24例及慢性血栓栓塞性肺高血压患者5例,共29例患者.其中13例患者院前已接受波生坦和(或)西地那非治疗,入院后加用吸入伊洛前列素治疗;16例无背景治疗患者入院后给予吸入伊洛前列素之后再联合内皮素受体拮抗剂和(或)5型磷酸二酯酶抑制剂治疗.观察住院期间患者的预后转归和右心功能指标的变化.结果 入选患者经过平均(23±13)d治疗,3例死亡,26例病情明显改善出院.治疗后,患者心率从(99±14)次/min降至(91±12)次/min(P=0.001);N末端B型利钠肽前体(NT-proBNP)从5 823(3 029～13 248) ng/L降至3 220(1 678～6 720) ng/L (P＜0.001);三尖瓣瓣环收缩期位移由(1.3±0.4) cm增至(1.4±0.3) cm(P =0.018),右心室左右径由(57±11) mm缩至(53±10) mm(P =0.040),上下径由(69±11) mm缩至(64±16) mm(P =0.027),右心收缩功能显著改善;胆红素水平由(41±34) μmol/L降至(26±17) μmol/L(P ＜0.001).所有患者均未出现无法耐受的不良反应.结论 以吸入伊洛前列素为基础联合其他靶向药物治疗合并重症右心衰竭肺高血压安全、有效.
目的 觀察以吸入伊洛前列素為基礎的聯閤治療策略對閤併嚴重右心衰竭肺高血壓患者的效果及安全性.方法 入選201 1年1月至2013年1月于同濟大學附屬上海市肺科醫院住院治療的世界衛生組織(WHO)肺高血壓功能分級為Ⅳ級的第一大類肺高血壓患者24例及慢性血栓栓塞性肺高血壓患者5例,共29例患者.其中13例患者院前已接受波生坦和(或)西地那非治療,入院後加用吸入伊洛前列素治療;16例無揹景治療患者入院後給予吸入伊洛前列素之後再聯閤內皮素受體拮抗劑和(或)5型燐痠二酯酶抑製劑治療.觀察住院期間患者的預後轉歸和右心功能指標的變化.結果 入選患者經過平均(23±13)d治療,3例死亡,26例病情明顯改善齣院.治療後,患者心率從(99±14)次/min降至(91±12)次/min(P=0.001);N末耑B型利鈉肽前體(NT-proBNP)從5 823(3 029～13 248) ng/L降至3 220(1 678～6 720) ng/L (P＜0.001);三尖瓣瓣環收縮期位移由(1.3±0.4) cm增至(1.4±0.3) cm(P =0.018),右心室左右徑由(57±11) mm縮至(53±10) mm(P =0.040),上下徑由(69±11) mm縮至(64±16) mm(P =0.027),右心收縮功能顯著改善;膽紅素水平由(41±34) μmol/L降至(26±17) μmol/L(P ＜0.001).所有患者均未齣現無法耐受的不良反應.結論 以吸入伊洛前列素為基礎聯閤其他靶嚮藥物治療閤併重癥右心衰竭肺高血壓安全、有效.
목적 관찰이흡입이락전렬소위기출적연합치료책략대합병엄중우심쇠갈폐고혈압환자적효과급안전성.방법 입선201 1년1월지2013년1월우동제대학부속상해시폐과의원주원치료적세계위생조직(WHO)폐고혈압공능분급위Ⅳ급적제일대류폐고혈압환자24례급만성혈전전새성폐고혈압환자5례,공29례환자.기중13례환자원전이접수파생탄화(혹)서지나비치료,입원후가용흡입이락전렬소치료;16례무배경치료환자입원후급여흡입이락전렬소지후재연합내피소수체길항제화(혹)5형린산이지매억제제치료.관찰주원기간환자적예후전귀화우심공능지표적변화.결과 입선환자경과평균(23±13)d치료,3례사망,26례병정명현개선출원.치료후,환자심솔종(99±14)차/min강지(91±12)차/min(P=0.001);N말단B형리납태전체(NT-proBNP)종5 823(3 029～13 248) ng/L강지3 220(1 678～6 720) ng/L (P＜0.001);삼첨판판배수축기위이유(1.3±0.4) cm증지(1.4±0.3) cm(P =0.018),우심실좌우경유(57±11) mm축지(53±10) mm(P =0.040),상하경유(69±11) mm축지(64±16) mm(P =0.027),우심수축공능현저개선;담홍소수평유(41±34) μmol/L강지(26±17) μmol/L(P ＜0.001).소유환자균미출현무법내수적불량반응.결론 이흡입이락전렬소위기출연합기타파향약물치료합병중증우심쇠갈폐고혈압안전、유효.
Objective To investigate the efficacy and safety of inhaled iloprost on top of other pulmonary hypertension (PH) specific therapies for patients with PH and severe right heart failure.Methods We consecutively enrolled WHO functional class Ⅳ patients with PH and chronic thromboembolic pulmonary hypertension (CTEPH) in Shanghai Pulmonary Hospital from January 2011 to January 2013.Inhaled iloprost was administrated to all enrolled patients,oral endothelin antagonist receptors (ERAs) and/ or type 5 phosphodiasterase inhibitors (PDE5-I) were also used as basis therapies.The in-hospital outcomes and the changes of right heart functional parameters were observed.Results Twenty-four patients with PH and 5 patients with CTEPH were enrolled.After a mean treatment duration of (23 ± 13) days,3 patients dead and significant improvement was observed in the remaining 26 patients.Compared with the baseline,heart rate decreased from (99 ± 14) to (91 ± 12) bpm (P =0.001),plasma NT-proBNP level decreased from 5 823 (3 029-13 248) to 3 220 (1 678-6 720) ng/L (P ＜ 0.001),tricuspid annular plane systolic excursion (TAPSE) increased from (1.3 ±0.4) to (1.4 ±0.3) cm(P =0.018),right ventricular diameter decreased(left-to-right diameter from (57 ± 11) to (53 ± 10) mm,P =0.040,and superoinferior diameter from (69 ± 11) to (64 ± 16) mm,P =0.027),Tbil also decreased from (41 ± 34) to (26 ± 17) μmol/L (P ＜ 0.001).No severe side effects were observed.Conclusion The strategy of inhaled iloprost on top of other PAH-specific target therapy medications is effective and safe for PH patients with severe right heart failure.
