前列腺素E_1对肺心病病人血流动力学参数及血气分析的影响

EFFECTS OF PROSTAGLANDIN E_1 ON HEMODYNAMICS AND BLOOD GAS IN PATIENTS WITH COR PULMONALE

①目的观察前列腺素E1(PGE1)对肺心病病人肺动脉高压血流动力学参数及动脉血氧分压影响.②方法将我院2001年6月～2004年12月的肺心病住院病人分成2组,治疗组59例,对照组25例.两组均对基础疾病进行常规治疗,而治疗组在此基础上加用PGE1 40 μg+生理盐水20 mL,每日2次静脉推注(5 ng·kg-1·min-1),共7 d.记录病人治疗前、后的超声检查结果及血气分析指标.③结果治疗后治疗组肺动脉收缩压(PASP)、肺血管阻力(PVR)、右心房内径(RA)、右心室内径(RV)下降明显(t=2.08～3.14,P＜0.05);而左心室射血分数(LVEF)、心排血量(CO)显著升高(t=2.73、3.04,P＜0.05);血氧分压(PaO2)及氧饱和度(SO2)有一定程度的下降,但差异无显著性.治疗组PASP、PVR下降较对照组明显(t=3.24、2.46,P＜0.05);PaO2及SO2有所下降,但差异无显著性.将治疗组病人按肺气肿类型分为支气管炎(BB)型和气肿(PP)型两类,两型在PGE1治疗后血流动力学状态均有改善,但PP型PaO2及SO2无明显下降,而BB型却下降较明显,两者差异有显著性(t=2.54、2.50,P＜0.05).④结论PGE1可显著降低肺心病病人的PASP和PVR,且对病人的PaO2及SO2有一定的影响,但如果病人的肺气肿类型为BB型,则对PaO2及SO2基本无影响.

Objective To investigate the effects of prostaglandin E1 （PGEl）on hemodynamics and blood gas analysis in patients with cor pulmonale. Methods Patients with cot pulmonale were randomly divided into treated group （n=59） and control group （n= 25）. A routine therapy was given to underlying diseases of all the patients. Beside the routine treatment, patients in the treated group were given PGE1 40/μg＋20 mL NS, iv, Bid× 7 d （rate of infusion; 5 ng· kg^-1 · min^-1）. An echocardiography and blood gas analysis were recorded before and after treatment. Results After the treatment, those in the treated group achieved significant decrease of pulmonary artery systolic pressure （PASP）, pulmonary vascular resistance （PVR）, internal diameter of right atrium/ventricle, but significant increase of left ventricular ejection fraction （LVEF） and cardiac output （CO）. The PaO2 and SO2 decreased, but not significantly. Compared with the control group, PASP and PVR improved significantly. According to emphysema type, the patients in the treated group were subdivided into pink puffer （PP） group and blue bloater （BB） group, both improved in hemodynamics after using PGE1. Compared with the PP group, the PaO2 and SO2 of BB group had a significant decrease. Conclusion PGE1 can significantly decrease the PASP and PVR of patients with cor pulmonale, and has some effect on PaO2 and SO2, but has little effect on PaO2 and SO2 of the patients with PP emphvsema.