前列地尔治疗次大面积肺栓塞合并肺动脉高压的效果观察

Observation of the effect of Alprostadil in the treatment of pulmonary hypertension secondary from submassive pulmonary embolism

目的 探讨前列地尔治疗次大面积肺栓塞合并肺动脉高压的治疗效果.方法 回顾性研究2009年1月-2013年12月在济宁医学院附属医院呼吸内科确诊的次大面积肺栓塞患者,经超声心动图检查筛选合并肺动脉高压患者.随机将患者分为对照组和治疗组,前者采用低分子肝素联合华法林抗凝治疗;后者并联合应用前列地尔注射液泵入治疗.分别在治疗前、治疗2w及出院3月后行超声心动图检查,比较治疗后两组患者肺动脉压变化情况.结果 筛选出入组患者21例,肺动脉收缩压42～ 73 mmHg,平均（56.43±7.02） mmHg.治疗2w后治疗组及对照组肺动脉收缩压均较治疗前降低（t=8.38,P=0.000; t=4.71,P=0.001）;但联合前列地尔治疗可以使肺动脉压下降更明显（t=4.53,P=0.000）;治疗方案对患者短期预后无明显影响,出现皮下瘀斑及注射部位疼痛不良反应可自愈.结论 联合前列地尔注射液治疗次大面积肺栓塞合并肺动脉高压效果显著,安全性高,值得临床推广.

Objective To investigate the effects of Alprostadil in treatment of secondary pulmonary hypertension from submassive pulmonary embolism. Methods From Jan 2009 to Dec 2013, patients with pulmonary hypertension, secondary from submassive pulmonary embolism, were diagnosed through ultrasound examination in our department. All patients were randomly assigned into control group and observation group, the former were treated with low molecular weight heparin （ LMWH ） and Warfarin for anticoagulant therapy; the latter were treated with LMWH, Warfarin, plus Alprostadil Injection. All patients were examined by ultrasound, respectively, before treatment, 2 weeks later, and 3 months after hospital discharg. Pulmonary arterial pressure of the two groups were compared to each other. Results 21 patients met criteria after screening, with pulmonary artery systolic pressure （ PASP ） ranging from 42mmHg to 73mmHg, an average PASP was （56.43±7.02） mmHg. Two weeks later, the PASP in observation group and the control group were both lower than that before treatment （t = 8.38, P = 0.000; t = 4.71, P = 0.001）; however, treatment combining with Alprostadil lowered the pulmonary arterial pressure significantly compared with the regiment without Alprostadil （t =4.53, P= 0.000）, There was no changes on the patients＇ short time prognosis between two treatment regiments. There was some minor side effects, such as subcutaneous ecchymosis and local pain that were both self-healed quickly. Conclusion It is safe and effective to treat pulmonary artery hypertension secondary from submassive pulmonary embolism with LMWH, Warfarin and Alprostadil Injection. This triple therapy should be recommended in clinical practice.