吸入伊洛前列素对慢性血栓栓塞性肺动脉高压患者血液动力学和氧动力学的即刻影响

目的 评价吸入伊洛前列素对慢性血栓栓塞性肺动脉高压(CTEPH)患者血液动力学和氧动力学的即刻影响.方法 采用前瞻性研究方法.对18例确诊的CTEPH患者置入右心导管,测定基线和吸入伊洛前列素20μg后即刻血液动力学和氧动力学参数并进行比较.结果 吸入伊洛前列素后,CTEPH患者肺动脉平均压从(53±11)下降到(47±14)mm Hg(1 mm Hg=0.133 kPa,P<0.01),右心房压从(10±6)下降到(7±6)mm Hg(P<0.01),肺血管阻力从(821±194)下降到(681±199)dyn·s·cm-5 (P<0.01),而心率、平均血压、肺动脉楔压、心排血量和体循环血管阻力无明显变化(均P>0.05);动脉血氧分压(PaO2)从(58±11)下降到(52±6)mm Hg(P<0.01),并伴有肺内分流和肺泡气-动脉血氧分压差增加(27±11)%比(33±9)%,(86±39)比(93±38)mm Hg,均P<0.01].结论 吸入伊洛前列素可即刻改善CTEPH患者的血液动力学,但同时可增加肺内分流,导致PaO2下降.

The acute effects of inhaled iloprost on hemodynamics and oxygenation in chronic thromboembolic pulmonary hypertension

Objective To evaluate the acute effects of inhaled iloprost on hemodynamics and oxygenation in chronic thromboembolic pulmonary hypertension (CTEPH).Methods A prospective study was made.Eighteen patients with CTEPH were enrolled.At right heart catheterisation,iloprost was inhaled at 20 μg for 10 -15 min.Compare the value of heart rate (HR),mean blood pressure (mBP),mean pulmonary arterial hypertension (mPAP),right atrium pressure (RAP),pulmonary arterial wedge pressure (PAWP),cardiac output (CO),pulmonary vascular resistance (PVR),systemic vascular resistance (SVR),arterial partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2),mixed venous saturation(SvO2),pulmonary shunt fraction (Qs/Qt),alveolar-arterial partial pressure of oxygen P (A-a) O2] before to after inhaled iloprost in these patients.Results Significant changes (before to after inhalation):mPAP,(53±11) to (47±14) mm Hg (P<0.01);PVR,(821±194) to (681±199) dyn·s·cm-5(P<0.01);RAP,(10±6) to (7±6) mm Hg (P<0.01).However,HR,PAWP,mBP,CO and SVR had no significant changes.At the same time,inhaled iloprost significantly decreased PaO2 from (58±11) to (52±6) mm Hg (P<0.01) and increased Qs/Qt from (27±11) % to (33±9)%(P<0.01)and P(A-a)O2 from(86±39) to (93±38)mm Hg(P<0.01).Conclusion Inhaled iloprost might instantly improve hemodynamics in CTEPH,but at the same time it increased arteriovenous shunts which resulted in lower PaO2.