前列腺素E_1在先心病重度肺动脉高压中的应用

The Application of Prostaglandin E1 for Patients with Congenital Heart Disease Associated with Pulmonary Hypertension

对３２例先天性心脏病合并重度肺动脉高压病人术前行前列腺素Ｅ１（ＰＧＥ１）治疗后，根据用药前后其肺动脉平均压、周围动脉血氧分压、血氧饱和度及心率、血压的变化，并结合肺活检指标进行对比研究。结果表明，ＰＧＥ１不但明显改善部分先心病重度肺动脉高压病人的血流动力学指标，而且可使部分病例Ｈｅａｔｈ分级ＩＩ级或ＩＩ级以下的肺血管病变结构趋向好转；ＰＧＥ１不仅有治疗作用，并对手术适应证有重要的参考价值。先天性心脏病合并肺动脉高压，术前应用ＰＧＥ１治疗，可提高手术安全性。

Aim:This study was conducted to evaluate the effect of prostaglandin E1 (PGE1) on surgical treatment in 32 patients with shunt type congenital heart defects associated with pulmonary hypertension.Clinical material and method:In 26 of 32 patients,the ratios between the mean pulmonary arterial pressure (MPAP) and the mean systolic arterial pressure (MSAP) were all >0.75.The direction of the shunt was mainly right to left in 10 patients.Continuous intravenous drip PGE1 was given at a speed of 15-20 ng/kg·min daily for two weeks before cardiac surgery.Hemodynamic changes detected by color Doppler-echocardiogram,data of arterial blood gas analyses and histologic alteration of small pulmonary arteries of lung biopsy were studied and compared between pre- and post-treatment with PGE1.Result:Extremely marked changes took place in hemodynamic parameters including drop of MPAP from 8.20±1.20 kPa to 6.19±1.11 kPa,increase of PaO2 from 9.10±1.20 kPa to 10.79±1.10 kPa and elevation of SaO2 from 90.80±3.25% to 95.34±1.81% (all P<0.001) and the amount of right to left shunt was markedly decreased.Slight regression of the medial thickening and the endothelial hyperplasia of the small pulmonary arteries from grade I to grade I-II were observed on the pathological sections of lung biopsies after a course of PGE1 treatment.Conclusion:Preoperative treatment with PGE1 can improve patient's cardiopulmonary hemodynamics and thus,reduce the operative mortality and morbidity.Its effects on cardiopulmonary hemodynamics can also be used as important criteria for selecting the patient for surgical treatment.