闭塞性肺动脉高压的血流动力学和急性药物试验  

Hemodynamics of Obliterative Pulmonary Hypertension With the Acute Vasodilator Test

作　　者：华毅[1] 程显声[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院肺血管病诊治中心,北京市100037

出　　处：《中国循环杂志》2010年第3期196-200,共5页Chinese Circulation Journal

基　　金："闭塞性肺动脉高压的诊治研究"国家攻关专题资助(75-62-02-40)

摘　　要：目的:研究闭塞性肺动脉高压,主要是慢性血栓栓塞性肺动脉高压(CTEPH)和原(特)发性肺动脉高压(PPH)的血流动力学特点和急性中西药物试验反应。方法:上世纪80年代对我院CTEPH患者46例(CTEPH组),PPH患者69例(PPH组)观察了右心导管术血流动力学变化,2组中对49例做了吸纯氧,21例舌下含服硝苯地平20mg,18例中心静脉推注川芎嗪80mg等急性药物试验。结果:82.60%(95/115)的患者诊断时已有中、重度[肺动脉平均压>40mmHg(1mmHg=0.133kPa)]肺动脉高压,56.52%(65/115)合并右心功能不全。PPH组肺动脉压(收缩压、舒张压及平均压)、心脏指数均高于CTEPH组,差异有统计学意义(P<0.05～0.001)。而体动脉收缩压CTEPH组高于PPH组,差异有统计学意义(P<0.05)。76%(37/49)吸氧患者肺动脉压下降,7例出现矛盾性升高,CTEPH组尤为明显(5例)。硝苯地平仅19%(4/21)有选择性扩张肺循环作用,部分患者副作用较明显。川芎嗪对肺循环降压作用轻微,副作用也较少。结论:我院就诊的闭塞性肺动脉高压患者绝大多数已属中、晚期,不可避免地会影响其治疗与预后。硝苯地平作为急性药物试验药物副反应较大,不宜应用,川芎嗪未显示对肺循环有良好的降压作用,副作用也较少。Objective： To study the hemodynamics of obliterative pulmonary hypertension including chronic thromboembolic pulmonary hypertension （CTEPH） and primary （idiopathic） pulmonary hypertension （PPH） with the acute vasodilator test of western medicine and traditional herbal medicine. Methods： We studied 115 eligible patients with obliterative pulmonary hypertension including 46 CTEPH and 69 PPH in 1980s. We observed the hemodynamic characters of the right heart, and performed the acute vasodilator test as follows： Pure oxygen inhalation in 49 patients, Nifedipine 20mg for sublingual administration in 21 patients, and Ligustrajine 80mg for intravenous administration in 18 patients. Results： There were 82.60% （95/115） of diagnosed patients suffered from moderate or severe pulmonary hypertension （ mPAP 〉 40mmHg, 1 mmHg = 0.133 kPa）, and 56.52% （65/115 ） of them combined with right heart failure. In PPH group, the patients＇ heart rate, pulmonary arterial pressure （systolic,diastolic and the mean pressure）, and cardiac index were higher than those in CTEPH group （P 〈 0.05 -0. 001 ）, however, the systemic blood pressure was higher in CTEPH group （P 〈 0.05 ）. There were 76% （37/49） of patients with oxygen inhalation showed decreased pulmonary arterial pressure, while 7 cases showed paradoxical elevation of pulmonary arterial pressure and 5 of them from CTEPH group. Nifedipine decreased the systemic circulation resistance,increased the cardiac index and slightly reduced pulmonary vascular resistance, only 19% （4/21） of them had puhnonary vascular dilation and some patients suffered from obvious side effect. Ligustrajine had weak effect for reducing the pressure of pulmonary circulation and meanwhile with the mild side effect. Conclusion： The majority of patients with obliterative puhnonary hypertension suffered from moderate or severe pulmonary hypertension as being diagnosed in 1980s, and therefore,their prognosis was not ideal. With the acute vasodilator test,

关 键 词：肺动脉高压 血流动力学 肺栓塞 硝苯地平 川芎嗪 

分 类 号：R541[医药卫生—心血管疾病]