吸入伊洛前列素和一氧化氮治疗新生儿肺动脉高压的疗效及护理对策

目的探讨吸入伊洛前列素和一氧化氮治疗新生儿肺动脉高压的临床疗效及护理对策。方法选取肺动脉高压新生儿50例,随机分为研究组和对照组,各25例。两组患儿均给予基础治疗和一氧化氮吸入治疗,研究组患儿加用伊洛前列素雾化吸入。比较两组患儿的气道压力、血气指标和血流动力学指标。结果治疗后,两组患儿平均气道压力均显著降低,研究组低于对照组;氧合指数和血氧饱和度均显著提高,研究组显著高于对照组;肺动脉收缩压均显著降低,研究组显著低于对照组。以上比较,差异均有统计学意义(P<0.05)。两组患儿治疗前后血压比较,差异无统计学意义(P>0.05)。结论新生儿肺动脉高压患儿吸入伊洛前列素和一氧化氮可有效降低气道压力和肺动脉收缩压、提高氧合水平,合理的护理方法能进一步提高疗效。     

雾化吸入伊洛前列素对新生儿持续肺动脉高压的临床疗效和安全性分析

目的:对持续性肺动脉高压的新生儿患儿采用雾化吸入伊洛前列素实施治疗的临床疗效和安全性进行分析探究。方法:选取2012年7月至2014年7月在我院接受治疗的患有持续性肺动脉高压的患儿90例,将其平均分为试验组和对照组,采用常规治疗方法对对照组患儿实施治疗,给予雾化吸入伊洛前列素对试验组患儿实施治疗,对比分析两组临床疗效情况以及不良反应出现人数情况。结果:试验组不良反应率(4.44%)与对照组不良反应率(33.33%)相比明显较低,有统计学意义(P<0.05)。试验组总有效率(91.11%)与对照组总有效率(59.99%)相比明显较高,有统计学意义(P<0.05)。结论:雾化吸入伊洛前列素对持续性肺动脉高压的患儿治疗的效果显著,安全可靠,值得推广。     

伊洛前列素

[通用名称] iloprost inhalation solution，伊洛前列素吸入溶液 [商品名]Ventavis [性状]本品为溶液剂，内容物为无色或黄色的澄清液体。 [化学名称]5-{（E）-（1S，5S，6R，7R）-7-羟基-6-[（E）-（3S，4RS）-3-羟基-4-甲基-1-辛烯-6-炔基]-双环[3．3．0]辛-3-亚基}-戊酸     

米力农注射液联合伊洛前列素治疗小儿先天性心脏病肺动脉高压的临床研究

目的探讨米力农注射液联合伊洛前列素治疗小儿先天性心脏病肺动脉高压(CHD-PAH)的临床疗效。方法选取2014年2月—2015年2月在郑州市儿童医院接受治疗的CHD-PAH患者64例,随机分为对照组(32例)和治疗组(32例)。对照组患者口腔雾化吸入吸入用伊洛前列素溶液,10μg混于生理盐水2 m L,10 min/次,6次/d。治疗组在对照组的基础上静脉注射米力农注射液,50μg/kg溶于葡萄糖溶液20 m L,缓慢注射5~10 min,然后0.5μg/kg的剂量溶于生理盐水50m L,持续泵入3 h。两组患者均连续治疗14 d。比较两组患者治疗前后临床疗效、血氧饱和度(Sp O2)、Borg评分、心脏功能分级(NYHAFC)、脑钠尿肽(BNP)以及右心导管检查结果。结果治疗后,对照组和治疗组的总有效率分别为75.00%和93.75%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组患者Sp O2均明显增加(P0.05);且治疗后治疗组增加更明显(P0.05)。治疗后,两组Borg评分、NYHAFC、BNP均显著降低(P0.05);且治疗组上述指标降低程度优于对照组(P0.05)。治疗后,两组肺动脉收缩压(s PAP)、肺动脉平均压(m PAP)、肺动脉收缩压/体循环收缩压(Pp/Ps)均明显降低,同时肺循环血流量/体循环血流量(Qp/Qs)比例升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组上述指标改善优于对照组,两组比较差异具有统计学意义(P0.05)。结论米力农注射液联合伊洛前列素治疗小儿CHD-PAH的效果显著,有利于患者心功能的改善,具有一定的临床推广应用价值。     

安立生坦联合伊洛前列素治疗肺动脉高压的临床研究

目的 探讨安立生坦联合伊洛前列素治疗肺动脉高压的临床疗效。方法 选择2020年5月—2022年5月在聊城市第二人民医院治疗的98例肺动脉高压患者,随机分为对照组（49例）和治疗组（49例）。对照组患者给予吸入用伊洛前列素溶液,2.5 μg/次,6次/d。在对照组基础上,治疗组口服安立生坦片,5 mg/次,1次/d。两组患者连续治疗7 d。观察两组患者临床疗效,比较治疗前后两组患者症状改善时间,6 min步行距离试验（6MWD）、Borg指数和肺动脉收缩压（PASP）指标,血清因子N末端B型利钠肽原（NT-proBNP）、内皮素-1（ET-1）、肿瘤坏死因子-α（TNF-α）和血管内皮生长因子（VEGF）水平,及不良反应情况。结果 治疗后,治疗组临床有效率为97.96%,明显高于对照组（81.63%,P＜0.05）。治疗后,治疗组症状改善时间均明显短于对照组（P＜0.05）。治疗后,两组6MWD明显升高,而Borg指数评分、PASP指标明显降低（P＜0.05）,且治疗组这些指标明显好于对照组（P＜0.05）。治疗后,两组血清因子NT-proBNP、ET-1、TNF-α、VEGF水平均明显低于治疗前（P＜0.05）,且治疗组明显低于对照组（P＜0.05）。治疗后,治疗组不良反应发生率为10.21%,对照组为12.24%,两组比较差异无统计学意义。结论 安立生坦联合伊洛前列素可显著降低肺动脉高压,改善肺血流动力状态,使机体炎性反应降低,且安全性高。     

治疗原发性肺动脉高压的新药:吸入性伊洛前列素

目的：介绍治疗原发性肺动脉高压的吸入性伊洛前列素。方法：对国内外相关文献进行综合归纳。结果和结论：吸入性伊洛前列素治疗可以降低肺血管阻力和延缓原发性肺动脉高压的进程。     

雾化吸入伊洛前列素联合一氧化氮吸入治疗新生儿持续性肺动脉高压的临床研究

目的观察雾化吸入伊洛前列素联合一氧化氮(NO)吸入治疗新生儿持续性肺动脉高压(PPHN)的临床疗效。方法将62例PPHN患儿随机分为试验组(31例)和对照组(31例)。对照组患儿吸入NO进行治疗,每次15 min,每天1次,持续治疗3 d。试验组患儿吸入NO治疗20 min后,吸入伊洛前列素50ng·kg^-1·min^-1,每次10 min,每天1次,持续治疗3 d。比较2组患儿的气道压力、血流动力学、血气指标及药物不良反应发生情况。结果治疗后,试验组和对照组的感染率均为32. 26%(10例/31例),再插管率分别为29. 03%(9例/31例),25. 81%(8例/31例),气管切开率分别为29. 03%(9例/31例),32. 26%(10例/31例),差异无统计学意义(P> 0. 05)。治疗后,试验组患儿导管前血氧饱和度、导管后血氧饱和度、气道压力、肺动脉压力(PAP)分别为(92. 26±12. 17)%,(89. 58±12. 18)%,(11. 57±6. 71) kP a,(25. 83±5. 37)mmH g,对照组...     

雾化吸入伊洛前列素治疗肺动脉高压的应用进展

伊洛前列素(Iloprost)是人工合成的前列环素类似物,通过雾化吸入给药治疗肺动脉高压(pulmonary arterialhypertension, PAH)的疗效和安全性已得到国际上多项临床研究的证实.     

伊洛前列素雾化吸入治疗全腔肺动脉连接术后肺动脉高压效果观察

目的评估吸入性伊洛前列素治疗全腔肺动脉连接术（total cavopulmonary connection,TCPC）后肺动脉高压（pulmongary arterial hypertension,PAH）临床疗效。方法选择2011年1月—2013年12月行TCPC术后合并PAH患儿12例,在停体外循环（cardiopulmonary bypass,CPB）后超声雾化吸入伊洛前列素,观察吸入前、吸入结束、吸入结束后30 min血流动力学、呼吸及血气分析参数。结果肺动脉收缩压、肺动脉压/体动脉压及中心静脉压吸入结束、吸入结束后30 min均低于吸入前,氧和指数高于吸入前（P〈0.05）。结论 TCPC术后吸入伊洛前列素可选择性舒张肺血管,降低肺循环阻力,改善肺部血流动力学。     

Effect of iloprost on biomarkers in patients with congenital heart disease‐pulmonary arterial hypertension

Some biomarkers play important roles in the endothelial dysfunction of patients with pulmonary arterial hypertension (PAH), including nitric oxide (NO), endothelin‐1 (ET‐1), asymmetric dimethylarginine (ADMA), galectin‐3 (Gal‐3), B‐type natriuretic peptide (BNP), and uric acid (UA). However, studies on these biomarkers in pulmonary artery blood in congenital heart disease‐PAH (CHD‐PAH) and the effect of iloprost on the regulation of biomarkers are lacking. This study investigated potential CHD‐PAH biomarkers and their association with the severity of disease. The effect of iloprost on the regulation of these biomarkers was also studied. A total of 31 patients with CHD‐PAH were enrolled. Seven with positive effects of iloprost (the average reduction in mPAP 11.13±1.73 mm Hg) and 19 with negative effects of iloprost (the average reduction in mPAP 4.21±4.87 mm Hg; iloprost positive group [IPG] vs iloprost negative group [ING], P<.01) and five age‐matched controls were studied. The pulmonary artery blood sample was collected before and after inhaling iloprost, and the plasma concentrations of Gal‐3, ADMA, ET‐1, and NO were measured. A significant positive linear relationship was observed between mPAP and plasma ET‐1, BNP, ADMA, and UA levels in all patients with CHD‐PAH. ET‐1, ADMA, BNP, and UA levels had a significant linear relationship with mean pulmonary arterial pressure, which could be used to predict the severity of CHD‐PAH. ET‐1 might be a potential biomarker to pre‐evaluate the effect of iloprost on CHD‐PAH. Iloprost could affect the expression of Gal‐3 and, therefore, the process of fibrosis could be influenced by iloprost.     

Clinical pharmacology and efficacy of inhaled iloprost for the treatment of pulmonary arterial hypertension

Similar to other prostanoids, iloprost is a potent vasodilator with considerable antiproliferative and anti-thrombotic properties, although the relevance of its ability to affect platelet aggregation in this subset of patients is unrecognized. The pathogenesis of pulmonary arterial hypertension (PAH) is a multifactorial and complex process secondary to an innate deficiency of substances that induce vasodilation and an overproduction of substances producing vasoconstriction. The production of endothelial vasoactive mediators such as nitric oxide, prostacyclin, endothelin-1, thromboxane and serotonin affect the growth of smooth muscle cells, which facilitate the development of structural remodeling changes that are characteristic of PAH. There have been remarkable advances in understanding the pathologic processes that are responsible for increasing pulmonary vascular resistance and that result in elevated pulmonary artery pressures in order to reverse and prevent progression of the disease process. The goals of treatment in these patients are to alleviate the patients’ symptoms, to improve functional capacity and to prevent the progression of the disease. The prostacyclin analogs, such as iloprost, have given hope to these patients who struggle under the burdens of this complex disease.     

Iloprost inhalation solution for the treatment of pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a condition that is characterised by increased pulmonary arterial pressure and vascular resistance that can lead to right ventricular failure and death. A variety of disturbances in pulmonary vascular endothelial and smooth muscle function are present in PAH, including reduced production of vasodilator and antiproliferative substances, such as nitric oxide and prostacyclin, and an overproduction of mitogens, such as endothelin. As a result of these observations, therapies have been developed for PAH that specifically target these pathogenic processes, including prostacyclin analogues and endothelin receptor antagonists. This article reviews iloprost inhalation solution, the most recently approved form of prostacyclin therapy that is delivered directly to the lungs by inhalation.     

Emerging therapies for pulmonary arterial hypertension

Pulmonary arterial hypertension is characterised by increased pulmonary vascular resistance due to increased vascular tone and structural remodelling of pulmonary vessels. The therapies that are in use so far have been developed to correct endothelial dysfunction and reduce vasomotor tone. These treatments have a limited effect on the remodelling process and, increasingly, the focus is turning to potent strategies for inhibiting vascular proliferation and promoting vascular apoptosis. Multiple novel targets have been uncovered over the last 5 years and several are now in early clinical trials. At present, it is clear that there is no single treatment for the condition. Although this is the case, studies are investigating the role of combining therapies that are already established.     

Inhaled treprostinil sodium for the treatment of pulmonary arterial hypertension

Introduction: Inhaled treprostinil sodium, a prostacyclin analog, is the most recent agent to receive FDA approval for the treatment of a fatal orphan disease: pulmonary arterial hypertension (PAH).

Areas covered: This article first reviews the data supporting the use of infusion prostacyclin and treprostinil as treatments for PAH. The authors then review inhaled treprostinil sodium: the compound and its properties, initial clinical evidence supporting its use and the pivotal data that support a role for inhaled treprostinil sodium in the treatment of patients with PAH. A broad PubMed literature search was done to identify the most current data on the use of treprostinil for PAH. Inhaled treprostinil received FDA approval to improve exercise tolerance in 2009, following the publication of several studies demonstrating its safety and its beneficial effect on hemodynamics, exercise capacity and quality-of-life measures.

Expert opinion: Inhaled treprostinil seems to have a similar efficacy profile as inhaled iloprost, although the demonstrated trough effect on exercise tolerance with treprostinil is an advantage. Perhaps more importantly, the longer half-life makes treprostinil more convenient with four-times-daily dosing. As compared with iloprost, inhaled treprostinil has practical advantages for patients (less frequent dosing, shorter inhalation times, once-daily preparation of the drug delivery device, and easier routine maintenance of the nebulizer), but direct comparisons about efficacy or durability of the treatment effect cannot be made in the absence of carefully controlled trials.     

Macitentan for the treatment of pulmonary arterial hypertension

Introduction: Pulmonary arterial hypertension (PAH) is a serious disease characterized by elevation of pulmonary artery pressures and right ventricular failure. It is a progressive disease with a poor 5-year survival despite recent advances in treatment. Endothelin plays an important role in the development and progression of the disease. Endothelin receptor blockers have been used to treat PAH since 2001. More recently, macitentan was approved for treatment of PAH.

Area covered: This review covers the preclinical and clinical data on macitentan.

Expert opinion: Macitentan is a more potent ERA and has been shown to delay progression of the disease. It does not appear to have any significant hepatotoxicity and has a convenient once-a-day dosing. In the large event driven trial, macitentan significantly reduced morbidity in patients with PAH. It was safe and well tolerated and the benefit was seen in treatment-naïve patients and those already receiving PAH therapy.     

Riociguat for pulmonary hypertension

Pulmonary hypertension, an elevation of the mean pulmonary artery pressure ≥25 mmHg, ultimately leads to premature death due to right ventricular dysfunction. Ten treatments from three classes of drugs are licensed for the management of pulmonary arterial hypertension. These treatments have improved exercise capacity but median survival is still poor. Additionally there are no licensed therapies for the other groups of pulmonary hypertension. Riociguat is a novel drug that stimulates soluble guanylate cyclase independently of nitric oxide and in synergy with nitric oxide. This review summarises the available evidence for riociguat in the treatment across all groups of pulmonary hypertension with a focus on pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.     

Treprostinil for the treatment of pulmonary hypertension

Background: Pulmonary hypertension (PH) is a severely disabling disorder characterized by sustained elevations of pulmonary arterial pressure, ultimately leading to right-heart failure and death. Pulmonary arterial hypertension (PAH) usually occurs in the absence of an evident cause (idiopathic PAH) or may be associated with connective tissue disease, HIV infection, congenital heart disease, chronic liver disease or result from the use of toxic agents and anorexigens. Objective/method: Intravenous epoprostenol has been widely used in patients with PAH, leading to long-term clinical benefits and improved survival. Epoprostenol has to be delivered through a permanently implanted Intravenous catheter. This may expose patients to potentially life-threatening complications. Thus, more stable compounds and alternative modes of prostacyclin delivery have been sought. Conclusion: Treprostinil sodium is a stable prostacyclin analogue, sharing pharmacologic actions similar to epoprostenol with comparable haemodynamic effects. Treprostinil is chemically stable at room temperature and has a long half-life (2 – 4 h), making this drug suitable for subcutaneous administration, with practical benefits in avoiding the risk of line infection and thrombosis, and cardiovascular reactions due to abrupt drug discontinuation.