脂微球前列腺素E1与硝酸甘油对风湿性心脏病合并肺动脉高压血流动力学的影响

目的观察脂微球前列腺素E1（Lipo PGE1）和硝酸甘油对风湿性心脏病（RHD）合并肺动脉高压（PH）患者的血流动力学的影响。方法将30例风湿性心脏病合并肺动脉高压患者随机分为Lipo PGE1组和硝酸甘油组各15例,经右侧颈内静脉穿刺放置Swan-Ganz漂浮导管,监测肺动脉压力〔收缩压（SPAP）、舒张压（DPAP）、平均肺动脉压（MPAP）及肺小动脉楔压（pulmonary artery wedge pressure,PCWP）〕,并通过温度稀释法测量心排血量（cardiac output,CO）,同时监测心率（HR）及平均动脉压（MAP）,计算肺血管阻力（pulmonary vascularresistance,PVR）和体循环血管阻力（systemic vascular resistance,SVR）。记录2种药物治疗20 min后血流动力学变化。结果 Lipo PGE1能有效降低PVR,提高患者CO,硝酸甘油致PVR、SVR、MAP及CO降低。结论 LipoPGE1可降低RHD合并PH患者的肺循环阻力,增加CO,改善心脏功能,同时避免血流动力学紊乱。

The effects of Lipo PGE1 and nitroglycerin on the hemodynamics in patients with pulmonary hypertension in rheumatic heart disease

Objective To investigate the effects of Lipo PGE1 and nitroglycerin on the hemodynamics in patients with pulmonary hypertension（PH） in rheumatic heart disease（RHD）.Methods 30 patients with PH in RHD were randomized into Lipo PGE1 group and nitroglycerin group（n=15 each）.Swan-Ganz catheter was introduced by puncture via the right internal jugular vein to monitor the systolic pulmonary artery pressure（SPAP）,diastolic pulmonary artery pressure（DPAP）,mean pulmonary artery pressure（MPAP） and pulmonary artery wedge pressure（PAWP）.The cardiac output（CO） was measured by thermodilution method;the heart rate（HR） and mean artery pressure（MAP） were monitored and pulmonary vascular resistance（PVR） and systemic circulation vascular resistance（SVR） were calculated,and the changes in hemodynamics within 20 min after drug treatment were recorded.Results Lipo PGE1 effectively reduced PVR and improved CO in patients,while nitroglycerin decreased PVR,SVR,MAP and CO.Conclusion Lipo PGE1 may reduce the pulmonary vascular resistance in patients with RHD complicated with PH,and increase their CO and improve the heart function,with no occurrence of the abnormalities in hemodynamics.