Iloprost Improves Gas Exchange and Exercise Tolerance in Patients with Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease
Iloprost Improves Gas Exchange and Exercise Tolerance in Patients with Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease
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DOI：
10.1159/000242498
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发表时间：
2010-01-01
期刊：
影响因子：
3.7
通讯作者：
Kinasewitz, Gary T.
中科院分区：
文献类型：
--
作者：
Dernaika, Tarek A.;Beavin, Mikel;Kinasewitz, Gary T.
背景：非选择性全身血管扩张剂使慢性阻塞性肺疾病(COPD)患者的通气、灌流(V/Q)匹配和气体交换恶化。吸入伊洛前列素有可能优先作用于肺的通气区，从而在保持肺泡通气量的同时降低肺动脉高压(PH)。目的：探讨吸入伊洛前列素对慢性阻塞性肺疾病(COPD)合并PH患者V/Q配型的急性影响。方法：对10例男性慢性阻塞性肺疾病合并高血压病患者吸入2剂伊洛前列素(2.5 mg)前后进行超声心动图检查。检测指标包括肺功能、动脉血气、6min步行试验(6MWT)、基础状态下、每次给药后30min和第二次给药后2 h的氧当量(V-E/VO2)和二氧化碳当量(V-E/VCO2)。结果：V-E/VCO2和V-E/VO2的平均差值分别为-13.3(95%CI-36.5~-2.7；p=0.002)和-15.0(95%CI-36.7~-0.4；p=0.02)，(A-a)梯度的平均变化为-3.7 mm Hg(95%CI为-6.1~-1.0；P=0.01)，而6MWT的平均改善为49.8m(95%CI 14.8至84.7；p=0.02)。维持伊洛前列素治疗后的动脉血气、静脉混合气、死腔分数和肺功能。第二次给药后，依洛前列素的作用可重现。最后一次服药后2小时，所有测量结果均恢复到基线水平。未发现对全身血压或血氧饱和度的不良影响。结论：伊洛前列素雾化吸入治疗COPD合并PH是安全的，且与改善V/Q匹配和运动耐量有关。版权所有(C)2009 S.Karger AG，巴塞尔
Background: Nonselective systemic vasodilators worsen ventilation perfusion (V/Q) matching and gas exchange in patients with chronic obstructive pulmonary disease (COPD). Inhaled iloprost has the potential to act preferentially in ventilated regions of the lung, thereby reducing pulmonary hypertension (PH) while alveolar ventilation is still maintained. Objectives: To investigate the acute effects of inhaled iloprost on V/Q matching in patients with COPD and PH. Methods: Ten males with COPD and PH on echocardiography were evaluated before and after inhaling 2 doses of iloprost (2.5 mu g). Measurements included lung function, arterial blood gas, 6-min walk test (6MWT) as well as ventilatory equivalents for oxygen (V-E/VO2) and carbon dioxide (V-E/VCO2) taken at baseline, 30 min following each dose of iloprost, and 2 h after the second dose. Results: Mean differences in V-E/VCO2 and V-E/VO2 were -13.3 (95% CI -36.5 to -2.7; p = 0.002) and -15.0 (95% CI -36.7 to -0.4; p = 0.02), respectively, and the mean change in (A-a) gradient was -3.7 mm Hg (95% CI -6.1 to -1.0; p = 0.01) after a single dose of iloprost, whereas mean improvement in 6MWT was 49.8 m (95% CI 14.8 to 84.7; p = 0.02). Arterial blood gas, venous admixture, dead space fraction and lung functions were maintained after iloprost. The effects of iloprost were reproducible after the second dose. All measurements returned to baseline 2 h after the last dose. No adverse effects on systemic blood pressure or oxygen saturation were seen. Conclusions: Iloprost inhalation was safe in patients with COPD and PH, and was associated with improved V/Q matching and exercise tolerance. Copyright (C) 2009 S. Karger AG, Basel