超声检测腺苷对先天性心脏病肺动脉高压血流动力学效应

Acute hemodynamic effect of intravenously infused adenosine in patients with pulmonary hypertension secondary to congenital heart disease by Doppler echocardiography

目的 观察外周静脉注射腺苷对先天性心脏病肺动脉高压的血流动力学影响。方法 选取先天性心脏病肺动脉高压患者 30例 ,肘静脉注射腺苷 75 μg/ kg,应用彩色多普勒超声心动图检测心率、平均动脉压、肺动脉收缩压、肺循环阻力、体循环阻力、肺动脉 /主动脉收缩压比值、肺循环 /体循环血流量比值及心室射血分数的变化 ,并与用药前的各项指标相比较。结果 静脉注射腺苷后 ,肺动脉收缩压、肺循环阻力及肺动脉 /主动脉收缩压比值与用药前比较明显下降 (P<0 .0 5 ) ,而肺循环 /体循环血流量比值及右室射血分数增加 (P<0 .0 5 )。心率、平均动脉压、体循环阻力、左室射血分数用药前后无明显变化 (P>0 .0 5 )。结论 腺苷选择性地作用于肺血管 ,降低肺动脉压力及肺循环阻力 ,并改善右心功能 。

Objective The purpose of this study was to examine the acute hemodynamic effect of intravenously infused adenosine in patients with pulmonary hypertension secondary to congenital heart disease.Methods Thirty consecutive patients with pulmonary hypertension secondary to congenital heart disease were studied.Heart rate, mean systemic arterial pressure,pulmonary arterial systolic pressure, pulmonary vascular resistance, systemic vascular resistance, the ratio of pulmonary/systemic systolic pressure (Pp/Ps), the ratio of pulmonary/systemic blood flow (Qp/Qs), left and right ventricular ejection fraction were estimated by color-Doppler echocardiography before,five and fifteen minutes after intravenous infusion of adenosine (75 μg/kg), respectively.Results Peripheral intravenous infusion of adenosine significantly decreased pulmonary arterial systolic pressure, pulmonary vascular resistance and Pp/Ps (P<0.05);at the same time,significantly improved Qp/Qs and right ventricular ejection fraction (P<0.05).There was no significant change in heart rate,mean systemic arterial pressure,systemic vascular resistance and left ventricular ejection fraction after intravenous adenosine infusion.Conclusion Adenosine is a selective pulmonary vasodilator,effectively controls pulmonary hypertension secondary to congenital heart diease;as an ideal agent it can estimate whether pulmonary hypertension is irreversible or not,thus guiding the clinical management of pulmonary hypertension.