肺动脉高压的药物治疗

肺动脉高压是以肺小动脉痉挛、内膜增生与重构为主要特征的一组临床与病理生理综合征,最终导致肺循环阻力进行性增加、右心功能衰竭直至死亡。动脉型肺动脉高压(PAH)的诊断还需满足肺小动脉楔压≤15mmHg,肺血管阻力>3Wood单位及心排血量正常或降低3个条件。肺动脉高压传统治疗效果差,不能延缓疾病进程。然而,近年来肺动脉高压发病机制研究与选择性作用于肺循环血管舒张药物的研发,已经证实能够改善疾病预后。治疗方法包括应用内皮受体拮抗剂、前列腺素类似物、磷酸二酯酶抑制剂、钙离子拮抗剂、一氧化氮、精氨酸等扩血管药物;应用抗凝剂;治疗右心功能不全及改善生活质量;应用外科手术等。本文主要对肺动脉高压的药物治疗进行综述。

Drug Treatment of Pulmonary Hypertension

Pulmonary hypertension is a set of clinical and pathological syndrome characterized as pulmonary arterial spasm, intimal hyperplasia and remodeling, which eventually leads to progressively increased pulmonary vascular resistance, and then right heart failure until to death. Artery type of pulmonary hypertension（PAH） is subject to the diagnosis such condition as the pulmonary artery wedge pressure below 15 mm Hg, pulmonary vascular resistance above 3 wood units and normal or lowered cardiac output. Traditional therapy has poor effect on this disease, and can not postpone its proceeding. However, recent researches about mechanism of this diseases and exploring of new vasodilatator specifically acted on lung circulation have testified their prospective in promoting prognosis. There are many treantments, such as the application of vasodilative drugs including endothelin receptor antagonists, prostaglandin analogues, phosphodiesterase inhibitors, calcium antagonists, nitric oxide, arginine, application of anticoagulants ; the treatment of right ventricular failure and improvement of the quality of life surgery and so on. This article reviews the drug treatment of pulmonary hypertension.