心脏移植术后早期静脉注射依诺前列环素(Iloprost)对血流动力学的影响

Effects Before and After Ⅳ Iloprost in Cardiac Transplantation Patients

目的:通过在同种异体原位心脏移植术后早期病人静脉持续注射依诺前列环素(Iloprost),观察用药前后体／肺循环血流动力学变化,寻找对术前合并肺动脉高压的心脏移植病人术后治疗的有效方案。方法:7例术前合并肺动脉高压的同种异体原位心脏移植病人,当术后早期肺动脉收缩压大于45 mmHg(1 mmHg= 0．133 kPa)时,开始静脉持续注射依诺前列环素,共8例次。药物剂量平均为2．2μg／h(1-6μg／h),持续时间平均54小时(36-68小时)。监测并记录用药开始和停药时的心排血指数(CI)、射血分数(EF)、中心静脉压(CVP)、平均肺动脉压(MPAP)、舒张末期心室容量(EDV)、肺循环阻力(PVR)和体循环阻力(SVR)。结果:心排血指数、射血分数、中心静脉压、平均肺动脉压、舒张末期心室容量、肺循环阻力和体循环阻力用药前后均有显著性差异(P<0．05-0.01)。7例病人均存活。结论:静脉持续注射依诺前列环素可以有效的降低术前合并肺动脉高压的心脏移植病人术后早期的肺循环阻力和肺动脉压力,改善血流动力学指标。药物副作用小。

Objective：Iloprost may be effective to reduce pulmonary arterial pressure and pulmonary vascular resistance（PVR） and increase cardiac index（CI）. In this study, intravenous （Ⅳ） Iloprost was given after cardiac transplantation. Hemodynamic indexes before and after iloprosy administration were observed. Methods：In 7 patients （mean age 52 years [ 46 to 58 years ] ,5 males）. Ⅳ Iloprost was given for 2.2 μg/hr（ range 1 to 6 μg/ hr） , and the infusion lasted for an average of 54 hours（ range 36 to 68 hours）. The variances for CI, ejection fraction （ EF）, central venous pressure（ CVP）, mean pulmonary arterial pressure （MPAP）, end-diastolic volume （EDV）, pulmonary vascular resistance （PVR）, systemic vascular resistance （SVR） before and after iloprost administration were measured. Results： The hemodynamic indexes for pre-iloprost/post-iloprost administration were CI： 2. 33 ± 0. 55 vs 3. 19 ± 0.66 L/min·m^2（P〈0.01） ,EF： 0.148±0.030 vs 0.236 ±0.042（P 〈0.001）,CVP： 9.87 ±3.48 vs 10.25 ±2.25 mmHg （P=0.74）,MPAP： 22.25 ±3.85 vs 17.75±4.13 mmHg（P〈0.05）,EDV： 320.83±54.65 vs297.17 ±54.05 ml（P〈 0.05）,PVR： 238.13±150.6 vs 112 ±53. 15 dyn· s^-1·cm^-5（P〈0.01）,SVR： 1380.63 ±266. 14 vs 966. 38 ±229.64 dyn·s^-1· cm^-5 （P 〈0.01 ）. All patients were discharged alive. Conclusions：Ⅳ iloprost can improve hemodynamics for patients undergoing cardiac transplantation.