依前列醇长期治疗原发性肺动脉高压的临床资料分析

Clinical study on long-term treatment of primary pulmonary hypertension with continuous intravenous epoprostenol infusion

目的 观察依前列醇长期治疗原发性肺动脉高压 (PPH)的疗效。方法 临床诊断为PPH且心功能为Ⅲ～Ⅳ级的慢性充血性心力衰竭患者 69例 ,均接受依前列醇长期静脉连续注入治疗(起始剂量在 2～ 62ng·kg- 1 ·min- 1 范围内。在长期治疗中 ,药物剂量应根据患者的反应进行调整 ,剂量通常随治疗时间每 2个月增加 1次 ,每次增加 1～ 2ng·kg- 1 ·min- 1 )并观察其疗效。用右心导管法和超声心动图检查法对所有患者测量三尖瓣跨瓣压 (ΔP)和心输出量 (CO)。随访期间每 4个月用超声心动图检查法复查上述指标 1次。结果 PPH患者长期用依前列醇治疗后 ,ΔP由 (84 1± 2 4 1 )mmHg (1mmHg=0 1 33kPa)降至 (62 7± 1 8 2 )mmHg(P <0 0 1 ) ,CO由 (4 0 0± 1 2 2 )L/min升至 (4 70± 1 2 7)L/min(P <0 0 2 ) ,ΔP/CO由 2 2 8± 9 4降至 1 4 9± 6 5(P <0 0 1 )。结论 长期静脉连续注入依前列醇治疗PPH ,可使患者右室压力逐渐下降 ,CO增加 。

Objective To observe the effects of treatment with long term continuous epoprostenol (Epo) infusion on the survival and pulmonary artery pressure in patients with primary pulmonary hypertension(PPH). Methods Sixty nine patients with PPH and congestive heart failure of stage Ⅲ or Ⅳ(classification by New York Heart Association )treated with Epo of initial dose of 2 62 ng·kg -1 ·min -1 (the dosage was euhanced by 1 2 ng·kg -1 ·min -1 every 2 months according to patient′s response).All patients underwent right heart catheterization and Doppler echocardiography to measure the systolic pressure gradient between the right ventricle and right atrium(ΔP) and the cardiac output(CO).Doppler echocardiography and catheterization data were compared. Patients were followed up with echocardiography once every 4 monthes. Results Of 69 patients treated with Epo 17 were followed up for >330 days. During this period, ΔP decreased from (84.1±24.1)mm Hg to (62.7±18.2) mm Hg ( P <0.01),CO increased from (4.00±1.22)L/min to (4.70±1.27)L/min( P <0.02),ΔP/CO decreased from 22.8±9.4 to 14.9±6.5 ( P <0.01). The patient survival was improved. Conclusions Patients with PPH treated with continuous infusion of Epo experienced a decrease in pulmonary artery pressure and an increase in cardiac output. Long term follow up of some patients of the group demonstrated improved survival during the period of Epo therapy.