Long term intravenous prostaglandin (epoprostenol or iloprost) for treatment of severe pulmonary hypertension
Long term intravenous prostaglandin (epoprostenol or iloprost) for treatment of severe pulmonary hypertension
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DOI：
10.1136/hrt.80.2.151
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发表时间：
1998-08-01
期刊：
影响因子：
5.7
通讯作者：
Sharples, L
中科院分区：
文献类型：
--
作者：
Higenbottam, T;Butt, AY;Sharples, L
目的探讨肺动脉高压的严重程度与治疗结果的关系。方法1982~1995年对98例原发性肺动脉高压患者进行随访，其中合并全身性疾病并肺动脉高压9例(6%)，血栓栓塞性肺动脉高压39例(27%)。长期静脉注射前列腺素(61例)或伊洛前列素(13例)，或常规口服抗凝剂(24例)加或不加钙通道阻滞剂。结果影响预后的因素有：纽约心脏协会评分1.52(95%可信区间1.11~2.09)；混合静脉血氧饱和度(SVO(2)%)0.97(0.95~0.98)；心脏指数0.72(0.49~1.06)；平均右房压1.04(1.01~1.07)；肺血管阻力1.02(1.00~1.04)。SVO患者的中位无事件生存期分别为239天(0~502天，22例)和585天(300~870天，42例)。SVO(2)大于或等于60%者，常规治疗组生存1275天(732~1818天，48例)，前列腺素治疗组986天(541~1431天，30例)。肺血管扩张能力不能预测治疗结果。结论：无论有无钙通道阻滞剂，持续静脉注射前列腺素能更有效地延长右心衰竭患者的生存期。在这些患者中，血管扩张能力并不能预测药物治疗的结果。
Objective-To investigate the relation between the severity of pulmonary hypertension and the outcome of medical treatment.Methods-98 patients with primary pulmonary hypertension-nine (6%) with systemic disease and pulmonary hypertension and 39 (27%) with thromboembolic pulmonary hypertension-received medical treatment and were followed between 1982 and 1995. They were given long term intravenous prostaglandin treatment (either lepoprostenol (n=61) or iloprost (n 13)) or conventional treatment with oral anticoagulants (n = 24) with or without calcium channel blockers. Event-free survival was measured to death or transplant surgery, or pulmonary thromboendarterectomy.Results-Prognosis (hazard ratio) was affected by: New York Heart Association grade, 1.52 (95% confidence interval 1.11 to 2.09); mixed venous oxygen saturation (Svo(2)%), 0.97 (0.95 to 0.98); cardiac index, 0.72 (0.49 to 1.06); mean right atrial pressure, 1.04 (1.01 to 1.07); and pulmonary vascular resistance, 1.02 (1.00 to 1.04). The median event-free survival time of patients with Svo, < 60% was 239 days (0 to 502) on conventional treatment (n = 22) and 585 days (300 to 870) on prostaglandin treatment (n = 42).No difference was seen in patients with Svo(2) greater than or equal to 60% between conventional treatment and prostaglandin treatment, survival being 1275 days (732 to 1818; (n = 48)) and 986 days (541 to 1431; n = 30)), respectively. Capacity for pulmonary vasodilatation did not predict outcome of treatment.Conclusions-Continuous intravenous prostaglandins were more effective than anticoagulants, with or without calcium channel blockers, in prolonging survival in patients with right heart failure. In these patients a capacity to vasodilate did not predict outcome fi om medical treatment.