雾化吸入伊洛前列素对肺动脉高压患者右心室功能的影响

Effects of inhaled aerosolized iloprost in adult patients with pulmonary arterial hypertension on right heart functions

目的探讨雾化吸入伊洛前列素对肺动脉高压患者右心室功能的影响。方法2010年1月至2010年12月于北京协和医院住院的30例肺动脉高压患者进行右心导管及超声心动图检查获得基线数据后雾化吸入伊洛前列素20μg进行血管扩张试验，吸入结束后即刻复测血流动力学及超声心动图，评估吸入药物前后右心功能的变化。结果所有患者吸入伊洛前列素后肺动脉平均压及肺循环阻力明显降低[（42．5±9．6）mmHg比（34．4±11．9）mmHg，P〈0．01；（9．6±5．7）Wood单位比（7．1±4．8）Wood单位，P〈0．001）]，右心室侧壁三尖瓣环收缩期速度峰值（TASm）明显升高[（10．7±2．1）cm／s比（11．9±2．5）cm／s，P〈0．01]，急性血管扩张试验阳性患者基线TASm显著高于阴性组（12．0±2．2）cm／s比（10．1±1．8）cm／s，P=0．01），急性血管扩张试验阴性组吸入伊洛前列素后TASm显著升高[（10．1±1．8）cm／s比（11．64-2．3）cm／s，P〈0．01]，差异无统计学意义（P〉0．05）。结论吸入伊洛前列素可显著降低肺动脉高压患者的肺动脉压及肺循环阻力，并改善右心室收缩功能。血管扩张试验阴性的患者与阳性的患者相比右心室功能受损更为严重，吸入伊洛前列素后右心室功能的改善更为明显。

Objective To explore the immediate effects of inhaled aerosolized iloprost on fight heart function in adult patients with pulmonary arterial hypertension （PAH）. Methods A total of 30 PAH patients were recruited. Right heart catheterization and echocardiography were performed before and immediately after the inhalation of iloprost （20 μg ）. Results After inhalation, the values of mean pulmonary artery pressure （PAPm） and pulmonary vascular resistances （PVR） decreased markedly（42. 5 ± 9.6 to 34. 4 ± 11.9 mm Hg, P 〈0.001 ; 9. 6 ±5.7 Wood unit to 7.1 ±4. 8 Wood unit, P 〈0. 001）. And the value of tricuspid annular systolic motion peak velocity （TASm） increased markedly [ （ 10. 7 ± 2. 1 ） cm/s vs （ 11.9 ± 2. 5 ） cm/s, P 〈 0. 01 ]. The baseline level of TASm was higher in acute responders than non-responders [ （ 12. 0 ± 2.2） cm/s vs （ 10. 1 ± 1.8 ） era/s, P = 0. 01 ] and TASm increased markedly after inhalation in non-responders [ （ 10. 1 ± 1.8 ） cm/s vs （ 11.6 ± 2. 3 ） cm/s, P 〈 0.01 ]. Conclusion The inhalation of iloprost decreases the levels of PAPm and PVR and improve fight heart functions in adult PAH patients. For non-responders, fight heart function is worse and more benefits may be achieved after the inhalation of iloprost.