Use of inhaled epoprostenol in transition to extubation in a patient after implantation of a ventricular assist device.
Use of inhaled epoprostenol in transition to extubation in a patient after implantation of a ventricular assist device.
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在植入心室辅助装置后的患者中使用吸入依前列醇过渡到拔管。
DOI：
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发表时间：
2010
影响因子：
2.8
通讯作者：
E. Schachter
中科院分区：
文献类型：
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作者：
M. Shapiro;C. Scurlock;J. Raikhelkar;A. Weiss;A. Anyanwu;E. Schachter
a a肺动脉高压（PAH）是一种危及生命的疾病，其特征是肺循环中的动脉压和血管阻力增加。1其定义为静息时平均肺动脉压（PAP）超过25 mmHg或运动时超过30 mmHg。2 PAH可能加重右心衰竭，这在许多需要心脏搭桥的心脏手术后患者中存在。这在已经放置左心室辅助装置的患者中尤其重要，因为右心室受益于肺循环中的后负荷减少。因此，在这些和其他情况下，如原位心脏移植和单双肺移植，通过药理学措施降低肺压力是有益的。然而，静脉（IV）肺血管扩张剂治疗也可能降低全身血压，导致全身性低血压，并可能损害冠状动脉灌注和右心功能。因此，这些患者通常在手术后用吸入性激素如依前列醇或一氧化氮治疗，以减少肺后负荷，同时避免收缩压降低。为了实现这一点，患者必须保持插管，直到他们对吸入性肺血管扩张剂的需求减少，并可以安全地停止。到目前为止，没有发表报告描述患者在停用吸入性依前列醇之前拔管。e描述了一名患者，在插入植入式LVAD（Jarvik 000; Jarvik Heart Inc，纽约，NY）治疗大面积心肌梗死引起的重度心力衰竭后，在使用氨氯前列醇（Flolan; GlaxoSmithKline，Research Tringle Park，NC）期间安全拔管。
a a ULMONARY ARTERY HYPERTENSION (PAH) is a life-threatening condition characterized by an increase in rterial pressure and vascular resistance in the pulmonary cirulation.1 It is defined by a mean pulmonary artery pressure PAP) of more than 25 mmHg at rest or more than 30 mmHg uring exercise.2 PAH may aggravate right-heart failure, which s present in many patients after cardiac surgery requiring ardiopulmonary bypass. This is particularly important in paients who have had placement of a left ventricular assist device LVAD) as the right ventricle benefits from afterload reduction n the pulmonary circulation. Therefore, in these and other ituations, such as orthotopic heart transplant and either singler double-lung transplant, it is beneficial to lower pulmonary ressures by pharmacologic measures. However, treatment ith intravenous (IV) pulmonary vasodilators may reduce sysemic blood pressure as well, leading to systemic hypotension nd may impair coronary perfusion and right-heart perforance. Thus, these patients commonly are treated with inhaled gents such as epoprostenol or nitric oxide postoperatively to educe pulmonary afterload while avoiding reductions in sysemic pressure. To accomplish this, patients must remain intuated until their requirements for inhaled pulmonary vasodilaors decrease and can be safely discontinued. To date, there are no reports published describing extubation f patients before inhaled epoprostenol has been discontinued. e describe a patient who was safely extubated while on nhaled epoprostenol (Flolan; GlaxoSmithKline, Research Tringle Park, NC) after insertion of an implantable LVAD (Jarvik 000; Jarvik Heart Inc, New York, NY) for severe heart failure rom a massive myocardial infarction.