吸入伊洛前列素和纯氧在肺动脉高压急性肺血管扩张试验中的对比研究

摘要

目的:本研究通过对先天性心脏病(CHD)合并重度肺动脉高压(PAH)患者在心导管术中行急性肺血管扩张试验,评估吸入纯氧和吸入伊洛前列素对血流动力学的影响,为合理选择和应用血管扩张药物提供依据.方法:本研究选择CHD合并重度PAH患者为研究对象,在心导管术中测定基础状态、吸氧试验后、吸入伊洛前列素药物试验后血流动力学参数,并进行比较.结果:本研究入选71例简单CHD合并重度PAH患者,中位年龄15岁(1.5 ～44岁).在吸氧试验和药物试验后,血流动力学参数均有明显改善.在吸氧后肺动脉平均压由(78.30±10.30) mmHg(1mmHg=0.133kPa)降至(75.85±10.41) mmHg,(P＜0.01),肺血管阻力指数由(23.30±9.51)WU·m2降至(16.52±8.47) WU·m2.在吸入伊洛前列素后,肺动脉平均压降至(74.37±9.95)mmHg(P＜0.01),肺血管阻力指数降至(19.49±8.75) WU · m2(P＜0.01),主动脉平均压无明显变化(P＞0.01),无严重不良反应发生.不同于药物试验,在吸氧试验中增加氧分压测定和校正可以有效减少误差.在判断肺血管反应性时,吸氧试验阳性率高于药物试验.结论:对于CHD合并重度PAH患者,吸入纯氧和伊洛前列素均可安全、有效的应用于急性肺血管扩张试验药物,但吸氧试验需要氧分压的校正.在本研究中吸氧试验阳性率要高于药物试验.%Objective:The objective of this study was to compare the efficacy of inhaled iloprost and 100％ oxygen in hemodynamic effects during acute vasodilative testing in patients with severe pulmonary arterial hypertension associated with congenital heart disease.Methods:We select patients with severe pulmonary arterial hypertension associated with simple congenital heart defect.All patients underwent standard right aud left heart catheterization.Hemodynamic parameters were measured and calculated using Fick method at baseline,then repeated after the inhalation of 100％ oxygen and aerosolised iloprost.Results:71 patients of severe pulmonary arterial hypertension associated with congenital heart disease were included.Their median age was 15 years (1.5-44years).Both inhaled pure oxygen and aerosolised iloprost,hemodynamics improved significantly.With pure oxygen,mean pulmonary arterial pressure decreased from (78.30 ± 10.30) mmHg to (75.85 ± 10.41)mmHg(P ＜ 0.01),and the pulmonary vascular resistance index dropped from (23.30 ± 9.51)WU· m2 to (16.52 ± 8.47) WU· m2 (P ＜ 0.01).Aftcr inhaled iloprost,mean pulmonary arterial prcssure dccreased to 74.37 ± 9.95mmHg(P ＜ 0.01),the pulmonary vascular resistance index dropped to (19.49 ± 8.75) WU· m2 (P ＜ 0.01),and the aortic blood pressure had no change (P ＞ 0.01).There were no cases of significant decreases in systemic blood pressure or severe adverse events.When inhaled pure oxygen,hemodynamic data should be adjusted by partial pressure of oxygen for reducing errors.During acute vasodilative testing,positive responders of oxygen inhalation were higher than those of inhaled iloprost.Conclusion:In patients with severe pulnonary arterial hypertension associated with congenital heart disease,both pure oxygen and aerosolized iloprost can be safely used as useful method in acute pulmonary vasodilative testing,but the results of inhaled pure oxygen should be adjusted.Positive rate of oxygen inhalation was higher than that of aerosolized iloprost in this study.