Novel approach for the management of sub-massive pulmonary embolism.
Novel approach for the management of sub-massive pulmonary embolism.
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DOI：
10.4103/1817-1737.98850
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发表时间：
2012-07-01
影响因子：
2.3
通讯作者：
Kashour, Tarek
中科院分区：
文献类型：
--
作者：
Idrees, Majdy M;Batubara, Enas;Kashour, Tarek
背景：右心室（RV）功能障碍已被确定为亚大块肺栓塞（SPE）的不良预后指标。我们假设，使用选择性血管扩张剂是有益的，在改善RV功能，在这种condition.METHODS患者：我们使用吸入前列环素类似物（伊洛前列素，万他维（））在5例SPE。螺旋CT血管造影证实肺栓塞，超声心动图用于评估RV状态。所有患者接受吸入伊洛前列素，2.5至5微克，每4小时为3 week.Results：患者前瞻性随访3个月。在开始伊洛前列素治疗前的基线和治疗后3天、3周和3个月进行评估。所有患者的功能分级、博格呼吸困难评分、NT pro-BNP水平和超声心动图参数均有显著改善。结论：在SPE中，针对降低肺血管阻力的治疗改善了相关的肺血流动力学损害，改善了RV功能。
BACKGROUND: Right ventricular (RV) dysfunction has been identified as a poor prognostic indicator in sub-massive pulmonary embolism (SPE). We hypothesized that using selective vasodilator agent is beneficial in improving RV function in patients with this condition.METHODS: We used inhaled prostacyclin analogue (Iloprost, Ventavis()) in five patients with SPE. Helical computerized tomography angiogram was confirmatory for pulmonary embolism and echocardiography was used to evaluate the RV status. All patients received inhaled Iloprost, 2.5 to 5 mug every 4 hours for 3 weeks.RESULTS: Patients were prospectively followed for 3 months. They were assessed at baseline before starting Iloprost treatment and at 3 days, 3 weeks, and 3 months after treatment. All patients showed significant improvement in their functional class, Borg dyspnea score, NT pro-BNP level, and echocardiographic parameters.CONCLUSION: In SPE, directing therapy toward decreasing pulmonary vascular resistance improves the associated pulmonary hemodynamic compromise and improves RV function.