吸入伊洛前列素在儿童先天性心脏病肺血管扩张试验中的应用

目的:该研究在心导管检查中通过对先天性心脏病(CHD)合并肺动脉高压(PAH)儿童,吸入伊洛前列素前后的血流动力学参数的测定,评价吸入伊洛前列素在CHD相关性PAH儿童急性肺血管扩张试验的安全性、有效性。方法:研究选择2007年6月至2010年5月,于北京安贞医院小儿心脏科住院的左向右分流型CHD合并重度PAH患儿,所有患儿行左、右心导管检查,并采用雾化吸入伊洛前列素,监测吸药前后血流动力学参数改变及不良反应。结果:该研究入选43例左向右分流型CHD合并重度PAH患儿,年龄(8.52±4.76)岁。吸入伊洛前列素后肺动脉平均压由(77.14±12.14)mmHg(1 mmHg=0.133 kPa)降至(69.35±12.14)mmHg(P<0.05);肺体循环血流量比值(Qp/Qs)由1.80±1.26升至3.06±2.90(P<0.05);肺血管阻力指数(PVRI)下降约5 Wood unit.m2〔吸入前(14.51±8.46)Wood unit.m2,吸入后(9.58±7.43)Wood unit.m2,P<0.05),体循环血压无明显变化〔吸入前(83.16±13.69)mmHg,吸入后(83.09±11.03)mmHg,P>0.05〕。以吸入伊洛前列素后PVRI较基础水平下降至少20%以上作为急性肺血管扩张试验阳性标准。肺血管反应阳性患儿31例,占72%,阴性反应患儿(PVRI下降<20%)12例,占28%。结论:对左向右分流型CHD合并重度PAH儿童在心导管检查中吸入伊洛前列素可明显降低肺血管阻力,体循环血压无明显变化,无明显不良反应发生,可作为安全有效的急性肺血管扩张试验的用药。

Effect of inhaled Iloprost during acute pulmonary vasodilator test in children with pulmonary arterial hypertension due to congenital heart disease

Objective:The aim of this study was to measure the hemodynamic during cardiac catheterization and acute vasodilator test,and to evaluate the efficacy and safety of inhaled Iloprost in patients with sever pulmonary arterial hypertension(PAH) associated with congenital heart disease(CHD).Methods: This study included the patients hospitalized in Beijng Anzhen hospital from June 2007 to May 2010,who were diagnosed with severe PAH associated with left to right shunting CHD.They all underwent standard right and left heart catheterization and a trial of inhaled Iloprost.The hemodynamic changes and clinical side effect of Iloprost were evaluated.Result: 43 patients with PAH and CHD inhaled Iloprost during cardiac catheterization.Their mean age was(8.52±4.76) year.After inhaled Iloprost,the mean pulmonary arterial pressure droped from(77.14±12.14) mmHg(1 mmHg=0.133 kPa) to(69.35±12.14) mmHg(P<0.05),the ratio of pulmonary blood flow to systemic blood flow(Qp/Qs) improved from 1.80±1.26 to 3.06±2.90(P<0.05),pulmonary vascular resistance index(PVRI) had a significant decrease from(14.51±8.46) Wood unit·m2 to(9.58±7.43) Wood unit·m2(P<0.05),while there is no significant change in systemic blood pressure(from(83.16±13.69) mmHg to(83.09±11.03) mmHg,P>0.05).A positive response defined as a significant decrease in PVRI ≥ 20%.Positive response were noted in 31 patients(account for 72%),17 patients were Iloprost unresponsive defined by PVRI drop<20%(account for 28%).Conclusion: Inhaled Iloprost caused significant decrease in PVRI during cardiac catheterization in children with PAH due to CHD.The systemic blood pressure remain unchanged and no server side effects was observed.Inhaled Iloprost may be a safe and effective agent for acute pulmonary vasodilator test in children with PAH due to CHD.