前列腺素E1和一氧化氮联合治疗室间隔缺损并肺动脉高压的疗效观察

目的 :观察静脉应用前列腺素E1(PGE1)、吸入一氧化氮 (NO)及二者小剂量联合应用对室间隔缺损 (VSD)并肺动脉高压的治疗作用。方法 :将 2 4例VSD并肺动脉高压的病人随机分为 3组 ,观察静脉注射PGE16 0ng/ (kg·min)、吸入NO 2 0ppm及静脉注射PGE130ng/ (kg·min)联合吸入NO 10 ppm对病人的血流动力学及血氧饱合度的影响。结果 :静脉注射PGE16 0ng/ (kg·min)使肺动脉平均压 (MPAP)明显下降 ,体动脉平均压 (MSAP)亦有所下降 ,心指数 (CI)明显增加。吸入NO 2 0 ppm组MPAP明显下降而MSAP无明显变化 ,CI有所升高 ,但差别不显著。静脉注射PGE130ng/ (kg·min)同时吸入NO 10 ppm组MPAP明显下降 ,但不显著 ,CI明显升高。 3组血氧饱合度均明显升高。结论 :联合应用小剂量PGE1和NO不仅能有效降低MPAP ,又能适当轻度降低MSAP ,改善心功能 ,减轻了NO的毒副作用 ,是一种较理想的治疗方案

Therapeutic Effects of Prostaglandin E1 Combined with Nitric Oxide on Ventricular Septal Defect Complicated by Pulmonary Hypertension

Objective To observe the therapeutic effects of intravenous prostaglandin E 1(PGE 1),inhaled nitric oxide(NO) and combined small doses of them for ventricular septal defect(VSD) complicated by pulmonary hypertension.Methods 24 patients with VSD complicated by pulmonary hypertension were divided into three groups randomly.In the first group PGE 1 60ng/(kg.min)was infused;in the second group,NO 20ppm was inhaled;in the last group PGE 1 30ng/(kg.min)and NO 10ppm were administrated.The hemodynamic variables and saturation of aterial oxygen(SaO 2) were measured.Results Intravenous PGE 1 60ng/(kg.min) resulted in a decrease in mean pulmonary arterial pressure (MPAP) ( P <0 01) and mean system arterial pressure(MSAP)( P <0.05) and an increase in cardiac index(CI)( P <0.05).Inhaled NO 20ppm resulted in a decrease in MPAP( P <0.01),but no significant change in MSAP and CI( P >0.05).Intravenous PGE 1 30ng/(kg.min) plus inhaled NO 10ppm resulted in a decrease in MPAP( P <0 01) and an increase in CI significantly ( P <0.01) with slight but not significant decrease in MSAP. SaO 2 of the three groups increased significantly ( P <0.01).Conclusion Small dose of PGE 1 puls small dose of NO can decrease MPAP effciently,decrease MSAP properly,improve heart function and decrease the side effects,so it is an ideal method to treat VSD complicated by pulmonary hypertension.