伊洛前列素在小儿先天性心脏病肺动脉高压术后的应用研究

The clinical research of Iloprost in the treatment of postoperative pulmonary arterial hypertension in congenital heart disease

目的:探究伊洛前列素治疗小儿先天性心脏病(CHD)术后肺动脉高压(PAH)的安全性及有效性。方法:选择合并PAH的CHD体外循环下行双心室矫治术患儿50例,年龄6个月～18岁,中位数年龄4.5(2.78,8.0)岁,分为吸入伊洛前列素组(组Ⅰ)、静注前列腺素E1(PGE1)组(组Ⅱ)。所有患儿均于术前放置PICCO及Swan-Ganz导管。通过术后测定、FICK法计算2组患儿用药前后血流动力学指标,包括体循环阻力指数、肺血管阻力指数。在相同通气条件下,比较2组患儿用药前后血流动力学指标在用药后48 h内的变化趋势。结果:伊洛前列素组肺体血管压力比(Pp/Ps):用药后即刻、用药后30 min较用药前差异有统计学意义(P<0.001);肺体循环阻力比(Rp/Rs):用药后即刻较用药前差异有统计学意义(P<0.05),用药后30 min较用药前差异有统计学意义(P<0.001);心排指数(CI):用药后即刻及用药后30 min差异有统计学意义(P<0.05)。结论:吸入性伊洛前列素是高效的选择性肺血管扩张剂,可以显著降低合并PAH的CHD术后患儿的肺动脉压力(PAP)和肺血管阻力(PVR)。应用吸入性伊洛前列素可以提高CHD术后患儿的CI。伊洛前列素用于治疗CHD术后PAH是有效安全的。

Objective, The purpose of this article is to discuss the effectiveness and the safety of the in- haled iloprost treatment in children with severe pulmonary arterial hypertension due to congenital heart disease immediately after cardiac surgery. Methods： From Feb. 2007 to Mar. 2009, 50 CHD patients 4. 5 （2. 78, 8.0） years old, who underwent the two ventricular repairs under cardiopulmonary bypass were involved in the study. They were evenly divided into two groups： Group I , the inhaled Iloprost group; Group 1I , prostaglan- din E1 1V group. The PICCO catheter and the Swan-Ganz catheter were used to monitor pulmonary arterial pres- sure （PAP）, arterial blood pressure （ABP） and cardiac index （CI）. The systemic vascular resistance index （SVRI） and pulmonary~ vascular resistance index （PVRI） were calculated by FICK principle. With the stand- ardized oxygenation and ventilation, the hemodynamic data both in and between the groups were measured dur- ing 48 hours post operative period. Results：Pp/Ps value decreased significantly at instant iloprost inhalation and 30 minutes after （ P 〈 0. 001 ）. Rp/Rs value also decreased signifcantly at instant iloprost inhalation （ P 〈 0. 05 ） and 30 minutes after （P 〈 0. 001 ）. Cardiac index increased immediately after iloprost inhalation and in 30 minutes later （ P 〈 0. 05 ）. Conclusion： Inhaled iloprost appears to be a higly recommended pulmonary vas- odilator. It can remarkably decrease the pulmonary arterial pressure and pulmonary vascular resistance in pa-tients with pulmonary hypertension after surgery. At the same time, inhaled iloprost can also enhanced CI. This study shows that Ilopmst is a safe and effective pulmonary vasodilator to be used for PAH patients with CHD af- ter surgery.