硫酸镁对慢性肺心病患者血流动力学和血气的急性影响

摘要

目的:评价硫酸镁（MgSO4）降低慢性肺心病患者肺动脉高压的急性疗效。方法: 采用右心漂浮导管检测法观察恒速静滴MgSO4（2% MgSO4，40 mg/min）对8例慢性肺心病伴肺动脉高压患者血流动力学和血气的影响。结果: 用药后30 min时，肺动脉平均压（mPAP）、肺血管阻力（PVR）、体动脉平均压（mSAP）和体循环总阻力（TSVR）均明显下降（P均＜0.05）。60 min时mPAP和PVR继续下降（分别下降13.37%和18.70%， P均＜0.05），下降幅度与用药前mPAP（r=0.712, P＜0.05）和用药前PVR(r=0.802, P＜0.01)呈显著正相关，而mSAP和TSVR较30 min时均有所回升（60 min时分别降低8.15% 和7.43%）。用药后对肺动脉、体动脉血气和其它血流动力学指标无不良影响。结论: MgSO4有急性降低慢性肺心病患者肺动脉高压作用，但对体动脉压亦有一定影响。%Objective: Our aim was to evaluate effects of magnesium sulfate(MgSO4) on pulmonary hypertension in patients with chronic pulmonary heart disease(CPHD). Methods: Eight patients with CPHD undergone right-heart catheterization. The parameters of hemodynamics and arterial blood gases in patients were measured before and after MgSO4 intravenous infusion(2% MgSO4,40 mg/min). Results: Mean pulmonary artery pressure(mPAP), pulmonary vascular resistance(PVR),mean systemic artery pressure(mSAP), and total systemic vascular resistance(TSVR) significantly decreased(P＜0.05) at 30 minutes after MgSO4 infusion. The decreased percentage of mPAP and PVR at 60 minute after MgSO4 infusion was 13.37% and 18.70% respectively(P＜0.05), but mSAP and TPVR decreased only by 8.15% and 7.43% respectively. The decreased degree of mPAP and PVR at 60 minutes after MgSO4 infusion significantly correlated with mPAP(r=0.712, P＜0.05)and PVR(r=0.802, P＜0.01) before MgSO4 infusion. No unfavorable effect of MgSO4 on other parameters of hemodynamics and arterial blood gases was found. Conclusion: Magnesium sulfate can attenuate pulmonary hypertension in patients with CPHD but may cause transient systemic hypotension.