法舒地尔对慢性阻塞性肺疾病急性加重期合并肺动脉高压患者安全性及有效性评价的研究

目的 探索法舒地尔对慢性阻塞性肺疾病急性加重期合并肺动脉高压患者肺循环血流动力学及氧动力学影响,从而评价法舒地尔在此类患者中的安全性和有效性.方法 对10例慢性阻塞性肺疾病急性加重期合并肺动脉高压患者给予静脉注射法舒地尔,行漂浮导管监测血流动力学及氧动力学变化.结果 10例患者用药前平均肺动脉压为(39.60±9.4) mmHg,在静脉注射法舒地尔48 h后可降至(32.63±6.05) mmHg,P＜0.05;72 h后降至(33.71±4.99) mmHg,P＜0.05;肺血管阻力指数仅表现存在下降趋势,由基线值(746.8±509.49) dyn·s·m2·cm-5下降为72 h时肺血管阻力指数为(482.43±198.21) dyn·s·m2·cm5,P＞0.05.其中3例患者在用药过程中发生血压降低,因而减小法舒地尔用量或暂停.心率、心脏指数、右室每搏功和肺动脉楔顿压等其他血流动力学参数无显著变化.用药后氧动力学指标提示氧摄取率、氧消耗指数、氧输送指数存在升高趋势,分流率存在降低趋势,但差异均无统计学意义.结论 静脉注射法舒地尔早期可降低慢性阻塞性肺疾病急性加重期合并肺动脉高压患者的肺动脉压力及肺血管阻力,改善缺氧,但仍需进一步评价其安全性.

Safety and effectiveness of fasudil in the patients of acute exacerbation chronic obstructive pulmonary disease with pulmonary hypertension

Objective To explore the safety and effectiveness of fasudil in the patients of acute exacerbation chronic obstructive pulmonary disease with pulmonary hypertension.Methods Ten patients of acute exacerbation chronic obstructive pulmonary disease with pulmonary hypertension received fasudil intravenous infusion.Hemodynamic and oxygen dynamics changes was monitored using Swan-Gans catheterization.Results The mean pulmonary artery pressure of the 10 patients before fasudil therapy was (39.60±9.4) mmHg.Forty-eight hours and 72 hours after fasudil intravenous infusion,the mPAP descended to (32.63±6.05) mmHg,P ＜0.05 and (33.71±4.99) mmHg,P ＜0.05.But PVRI only performed the trend of decrease,from (746.8± 509.49) dyn· s· m2 · cm-5 of baseline to (482.43±198.21) dyn· s·m2· cms of 72 h,P ＞0.05.Hypotension happened in 3 of 10 patients while using fasudil,which could resume through reducing the dose or pause.There were no significant changes of heart rate,cardiac index,right ventricular stroke work and pulmonary artery wedge pressure.The oxygen dynamics result showed,the oxygen uptake rate,oxygen consumption index,oxygen delivery index are of rising trend,Qs/ Qt in reduce trend.Conclusions Fasudil intravenous infusion could reduce the pulmonary artery pressure and pulmonary vascular resistance while improving hypoxia in the early stage of acute exacerbation chronic obstructive pulmonary disease with pulmonary hypertension.But the safety still need to be further evaluated.