Comparison of inhaled nitric oxide with aerosolized prostacyclin or analogues for the postoperative management of pulmonary hypertension: a systematic review and meta-analysis

Abstract

Background: This study aims to compare the effectiveness of inhaled prostacyclin or its analoguesversus nitric oxide (NO) in treating pulmonary hypertension (PH) after cardiac or pulmonary surgery remains unclear.

Methods: PubMed, Cochrane, and Embase databases were searched for literature published prior to December 2019 using the following keywords: inhaled, nitric oxide, prostacyclin, iloprost, treprostinil, epoprostenol, Tyvaso, flolan, and pulmonary hypertension. Randomized controlled trials and multiple-armed prospective studies that evaluated inhaled NO versus prostacyclin (or analogues) in patients for perioperative and/or postoperative PH after either cardiac or pulmonary surgery were included. Retrospective studies, reviews, letters, comments, editorials, and case reports were excluded.

Results: Seven studies with a total of 195 patients were included. No difference in the improvement of mean pulmonary arterial pressure (pooled difference in mean change= ?0.10, 95% CI: ?3.98 to 3.78, p?=?.959) or pulmonary vascular resistance (pooled standardized difference in mean change= ?0.27, 95% CI: ?0.60 to 0.05, p?=?.099) were found between the two treatments. Similarly, no difference was found in other outcomes between the two treatments or subgroup analysis.

Conclusions: Inhaled prostacyclin (or analogues) was comparable to inhaled NO in treating PH after cardiac or pulmonary surgery.

• Key messages

• This study compared the efficacy of inhaled prostacyclin or its analogues versus inhaled NO to treat PH after surgery. The two types of agent exhibited similar efficacy in managing MPAP, PVR, heart rate, and cardiac output was observed.

• Inhaled prostacyclin may serve as an alternative treatment option for PH after cardiac or pulmonary surgery.

     

慢性低氧大鼠肺动脉内皮素mRNA的表达及定位

目的：探讨慢性低氧大鼠肺动脉内皮素－1基因表达及分布。方法：采用生物素标记cRNA探针，对Wistar大鼠肺动脉进行原位杂交。结果：低氧1周组及低氧2周组大鼠大部分肺动脉内皮细胞ET－1mRNA表达呈阳性信号，而对照组大鼠仅极少数阳性信号（P＜0．01）；低氧1周组大鼠部分显示强阳性信号。低氧1周组及低氧2周组大鼠部分肺动脉平滑肌细胞呈现ET-1mRNA表达阳性信号，而对照组大鼠则无阳性信号表达（P＜0．01及0．05）。结论：慢性低氧对大鼠肺动脉ET－1分泌的影响是在基因转录水平进行，且主要细胞定位在肺动脉内皮细胞，此外还包括肺动脉平滑肌细胞。     

支气管肺蠊缨滴虫病的临床诊治进展

支气管肺蠊缨滴虫感染是一种新的寄生虫疾病,1993年至2008年国内共确诊48例,临床诊断和治疗有一定进展,但蠊缨滴虫感染病例的临床表现缺少特征性,蠊缨滴虫自然宿主、传播途径、流行区域及致病机制等多个方面也尚不明确,其生物学分类地位也有争议,国内还没有建立抗原抗体检测或分子生物学鉴定方法.     

Chronic obstructive pulmonary disease and asthma General and medical management with special attention to exacerbations

The general management of patients with chronic obstructive pulmonary disease and asthma is discussed. Pathophysiological mechanisms of bronchial obstruction and inflammation are briefly described. The importance of preventive measures is emphasized. Medicine prescribed in chronic obstructive pulmonary disease and asthma, their relative place in treatment schedules and route of administration are reviewed. Finally, the importance of maximal bronchodilatation in exacerbations is stressed and the few indications for antibiotic treatment are discussed.     

在深静脉血栓—肺栓塞病程中腔静脉滤器的应用价值分析

目的：探讨腔静脉滤器(Vena cava filter VCF)在深静脉血栓(Deep venous thrombosis DVT)—肺栓塞(Pulmonary embolism PE)病程中的应用价值。方法：结合本组25例高危深静脉血栓一肺栓塞患者，对其中24例置放5种构型的永久型或临时型下腔静脉滤器(IVCF)26枚的临床疗效、影响病程与预后因素及病生理改变，复习文献分析讨论。结果：DVT有可能脱落导致PE或致死性肺栓塞；置放IVCF可有效预防肺栓塞，早期进行溶栓治疗，改变预后。结论：严格按适应证植入IVCF，对DVT—PE的早期治疗和预防致死性肺栓塞有重要意义，但其应用价值需进行综合评价和进一步探讨。     

Regression of Pulmonary and Multiple Skeletal Metastases from Renal Cell Carcinoma by Nephrectomy and Alpha-interferon Therapy: A Case Report

We report a rare case of advanced renal cell carcinoma in apatient who showed complete resolution of metastases to thelung and bones after nephrectomy, partial jejunectomy and subsequentalpha-interferon therapy. The patient was a 54-year-old manwhose right lung and left femur metastases were detected beforenephrectomy. In the seventh week after nephrectomy, a partialjejunectomy was carried out because of the obstructive ileuscaused by intraluminal multiple metastases of the jejunum. Apathological fracture of the metastasized right humerus occurredsubsequently. After four months of intramuscular alpha-interferonadministration (3x106 units/day), however, x-rays revealed thecomplete disappearance of the metastatic lung shadow and a solidunion of the humerus, and there were no tumor cells in the femurspecimen resected at the subsequent reconstruction surgery ofthe left leg. Seven years have passed from onset, and the patientis still alive and disease free.     

胸部高分辨率CT检查技术的临床应用

笔者对５０例肺部疾病胸部常规ＣＴ和高分辨率ＣＴ（ＨＲＣＴ）图像进行了对照分析。其中特发性肺间质纤维化（ＩＦＰ）８例，肺转移癌５例，支气管扩张１５例，慢性阻塞性肺气肿１５例，周围型肺癌７例，结果表明：ＨＲＣＴ在ＩＦＰ、支气管扩张和肺气肿的显示明显优于常规ＣＴ（Ｐ＜０．００１），在对肺部原发或转移性肿瘤的显示能提供更多的诊断信息。笔者还讨论了ＨＲＣＴ的检查技术和图像后处理，分析了影响ＨＲＣＴ的若干因素，指出通过缩小视野（ＦＯＶ），减少象素做图像的重建放大显示肺部局部结构更为清楚方便，应灵活运用。     

完全性肺静脉异位引流的手术治疗经验

为评估影响完全性肺静脉异位引流（ＴＡＰＶＤ）手术纠治的因素，本组纳入了２８例在中度低温体外循环和１５例在深低温停循环下手术纠治者。结果手术死亡４例，死亡率９．３％。随访３２例，２例肺静脉回流梗阻分别于术后５个月和２年３个月死亡。结论认为，ＴＡＰＶＤ必须早期手术防止肺血管阻塞性病变；术后定期随访；改进手术方法，防止心房内补片粘连所致肺静脉回流梗阻。     

肺隔离症的影像诊断和介入治疗

目的探讨肺隔离症的影像学表现及介入治疗的应用价值. 资料与方法对5例肺隔离症患者的X线平片、CT、MRI表现进行分析,并对隔离的肺组织的供血动脉进行栓塞. 结果 X线平片主要表现为囊状或团状高密度影及支气管扩张样改变,CT、MRI可发现部分异常供血动脉,血管造影均能发现供血动脉,经异常供血动脉采用不锈钢圈栓塞后临床症状逐渐减轻、消失,随访6个月～1年,症状未再复发. 结论在影像诊断方面,X线平片难以确诊,CT、MRI可部分确诊,而DSA检查是肺隔离症诊断的金标准.经异常供血动脉栓塞治疗肺隔离症安全,患者痛苦小,并发症少,是一种有效的治疗方法.     

肺表面活性物质治疗新生儿胎粪吸入综合征的临床研究

目的探讨肺表面活性物质（ＰＳ）治疗新生儿胎粪吸入综合征（ＭＡＳ）的有效性及临床价值。方法采用气管内滴入ＰＳ治疗８例ＭＡＳ患儿，其中６例接受ＰＳ２剂，２例接受ＰＳ３剂。结果给予首剂ＰＳ后１０分钟患儿青紫迅速消失，皮肤转红润，经皮测定血氧饱和度（ＴｃＳａＯ２）升高。３０分钟后患儿低氧血症迅速改善，动脉血氧分压、动脉血氧分压与吸入氧浓度比值、动脉肺泡血氧分压比值、呼吸机有效指数较治疗前显著增高，分别由原来的５２８±０９８ｋＰａ、８６６±３５２ｋＰａ、０１２±００６ｋＰａ及０１４±００６ｍｌ·ｋＰａ－１·ｋｇ－１增加到８９１±１４３ｋＰａ、１６８１±４１８ｋＰａ、０２１±００５ｋＰａ及０２６±００７ｍｌ·ｋＰａ－１·ｋｇ－１；而吸入氧浓度及平均气道压逐渐降低，由原来的０６８±０１９ｋＰａ及２２０±０４２ｋＰａ降低到０５３±００８ｋＰａ及１９３±０４８ｋＰａ。重复应用ＰＳ后亦有相似效果。结论ＰＳ能有效地改善ＭＡＳ患儿肺顺应性及氧合功能。重复应用ＰＳ可巩固和加强疗效。