摘要
目的评价吸入伊洛前列素对先天性心脏病术后肺动脉高压的疗效，并初步探讨其机制。方法以中国医学科学院阜外心血管病医院小儿心脏中心PICU收治的体外循环下双心室矫治手术后合并肺动脉高压13例患儿为研究对象，在术后48h内常规治疗的基础上，给予有效剂量伊洛前列素25ng／（kg·min），每次吸入10min，每4小时1次。观察患儿的血流动力学改变，采用酶联免疫吸附法检测血浆cAMP和cGMP浓度。结果13例患儿平均年龄（17．88±12．56）个月，平均体质量（9．29±3．59）kg。治疗前右房压、肺动脉收缩压、肺动脉收缩压／主动脉收缩压比值分别是（11．5±1．41）mmHg（1mmHg=0．133kPa）、（61．64±13．6）mmHg和0．66±0．16；治疗后20min分别降至（9．88±1．88）mmHg、（47．67±12．18）mmHg和0．52±0．15；治疗前后差异均有显著性（P〈0．01）。治疗后120min伊洛前列素疗效仍然存在。治疗前患儿血浆cAMP浓度为（335．75±127．31）μg/L，治疗后20min升至（519．68±148．54）μg/L，治疗前后差异有显著性（P〈0．01）。治疗前后血压、呼吸机条件和血浆cGMP浓度没有明显变化（P〉0．05）。结论对于先天性心脏病术后合并肺动脉高压患儿，吸入伊洛前列素可以显著降低肺动脉压力、改善肺循环血流动力学状态，可能与增高血浆cAMP浓度有关系。吸入伊洛前列素对体循环和呼吸功能影响小，未观察到明显不良反应。
Objective To study the therapeutic effects of inhaled iloprost on pediatric pulmonary hypertension after congenital heart disease operation and to investigate the mechanisms of iloprost. Methods Thirteen patients of postoperative pulmonary hypertension were given effective dose of iloprost 25 ng/（ kg · min）, 10 rain every time,every 4 hours for 48 h after the surgery. We used the 24 h cardiac monitoring and ultrasonic cardiography for hemodynamical monitoring. We examined the blood cAMP and cGMP by ELISA assay. Results The patients were （ 17. 88 ± 12. 56 ） months old with average weight of （9. 29 ± 3.59 ） kg. The right atrial pressure, systolic pulmonary arterial pressure, systolic pulmonary arterial pressure/systolic blood pressure were（ 11.5± 1.41 ）mm Hg, （61.64 ± 13.6） mm Hg and 0. 66 ±0. 16 before the treatment and they were （9. 88 ± 1.88） mm Hg, （47.67 ± 12. 18） mm Hg and 0. 52 ±0. 15 at the time point of 20 min after the treatment. For all the three parameters, there were significant differences before and after treatment. The effect of iloprost continues to 120 min later. The cAMP level was（335. 75 ± 127. 31 ） μg/L before iloprost inhalation and increased to（519. 68 ±148.54） μg/L at the time point of 20 min after inhaling iloprost, showing a significant difference（ P 〈 0. 01 ）. Blood pressure, cGMP level and ventilator parameters showed no notable difference before and after the treatment. Conclusion Inhaled iloprost significantly improves pulmonary hemodynamics in children with pulmonary hypertension after congenital heart disease operation, which might be achieved by increasing the blood cAMP. However, systemic blood pressure and respiratory function keep unaffected after iloprost inhalation.
出处
《中国小儿急救医学》
CAS
2009年第3期231-233,共3页
Chinese Pediatric Emergency Medicine
