吸入伊洛前列素对不同类型肺动脉高压患者氧动力学的影响

The oxygen kinetic effect of inhaled iloprost in pulmonary artery hypertension and chronic thromboembolic pulmonary hypertension

目的分析雾化吸入伊洛前列素对动脉型肺动脉高压（PAH）及慢性血栓栓塞性肺动脉高压（CTEPH）患者的氧动力学的急性影响。方法顺序收集北京朝阳医院2006年6月至2009年1月连续收治的明确诊断为PAH的患者22例及CTEPH患者24例，均行右心导管检查，监测基线状态及吸人伊洛前列素20μg后的即刻血流动力学特征，同步抽取肺动脉及股动脉血行血气分析，计算氧动力学参数。结果基线状态PAH及CTEPH患者的PaO2分别为（63±10）mmHg（1mmHg=0．133kPa）及（59±10）InmHg，氧输送指数（DO2I）分别为（458±136）ml·min^-1·m^-1及（386±92）ml·min^-1·m^-1，氧消耗指数分别为（135±53）ml·min^-1·m^-1及（131±43）ml·min^-1·m^-1。吸入伊洛前列素后即刻，2组患者肺内分流率均显著升高（均P〈0．01），P[A-a]O2显著升高（均P〈0．01）；动脉血氧含量均显著降低（均P〈0．05）；混合静脉血氧合指标及氧摄取率无明显变化；DO2I无明显增加，氧消耗指数出现不同程度降低；2组患者各项氧动力学参数变化幅度无差异。基线状态CTEPH患者混合静脉血氧饱和度（SvO2）、静脉血氧含量（CvO2）及DO2I均显著低于PAH患者（均P〈0．05）。吸药后，CTEPH患者PaO2、SvO2及CvO2均显著低于PAH患者（均P〈0．05）。结论PAH及CTEPH患者存在低氧血症及氧动力学异常；雾化吸人伊洛前列素后患者肺内分流增加，氧动力学状态无改善。CTEPH患者的氧动力学状态较PAH患者更差，应用伊洛前列素时需加强氧合功能监测，必要时给予氧疗支持。

Objective To study the acute oxygen kinetic effect of inhaled iloprost in pulmonary artery hypertension and chronic thromboembolic pulmonary hypertension. Methods Twenty-two and 24 patients who were admitted to our hospital between June 2006 and January 2009 with confirmed dignosis of pulmonary arterial hypertension （PAH） and chronic thromboembolic pulmonary hypertension （CTEPH） respectively were enrolled to this study. During right heart catheterization, the hemodynamics and oxygen kinetics were monitored at baseline and after inhaling Iloprost （20 micrograms）. Results At baseline, the arterial partial pressure of oxygen （PaO2 ） was （63 ± 10）mm Hg （1 mm Hg = 0. 133 kPa） and （59 ± 10） mm Hg respectively in PAH and CTEPH patients, and the oxygen delivery index （DO2I） and oxygen consumption index （VO2I） were （458 ± 136）ml · min^-1·m^-2and （135 ±53） ml · min^-1·m^-2 in PAH patients respectively, and （386 ± 92） ml · min^-1·m^-2 and （131 ±45） ml · min^-1·m^-2 in CTEPH patients respectively. Three minutes after inhaling Iloprost, for PAH and CTEPH patients, the pulmonary shunt rate （Qs/Qt） all increased significantly （ all P 〈 0. 05, respectively） as well as the difference of oxygen partial pressure between pulmonary alveoli and artery （ P[A-a] O2, all P 〈 0. 05, respectively）, and the arterial oxygen content （ CaO2 ） all decreased significantly （ all P 〈0. 05, respectively）. The oxygenation parameters of mixed venous blood, oxygen extractive rate and DO2I did not change significandy, but VOzI declined to different extent. The extent of change after inhaling Iloprost for all oxygen kinetic parameters were similar between PAH and CTEPH patients. At baseline, mixed venous oxygen saturation （ SvO2 ）, venous oxygen content （ CvO2 ） and DO2I in CTEPH patients were lower than those in PAH patients. After inhaling Iloprost, in CTEPH patients, PaO2, SvO2 and CvO2 were lower than those in PAH patients. Conclusion There were hypoxemia and abnormality of oxygen kinetics in PAH and CTEPH patients. After inhaling Iloprost, pulmonary shunt increased whitout improvement in oxygen kinetics. Oxygenation should be monitored closely and supply oxygen supplied for CTEPH when inhaling Iloprost.