TREATMENT OF PRIMARY PULMONARY-HYPERTENSION WITH CONTINUOUS INTRAVENOUS PROSTACYCLIN (EPOPROSTENOL) - RESULTS OF A RANDOMIZED TRIAL
TREATMENT OF PRIMARY PULMONARY-HYPERTENSION WITH CONTINUOUS INTRAVENOUS PROSTACYCLIN (EPOPROSTENOL) - RESULTS OF A RANDOMIZED TRIAL
复制标题
DOI：
10.7326/0003-4819-112-7-485
复制
发表时间：
1990-04-01
影响因子：
39.2
通讯作者：
LONG, W
中科院分区：
文献类型：
--
作者：
RUBIN, LJ;MENDOZA, J;LONG, W
目的：探讨持续静脉滴注前列环素(爱普前列醇片)治疗原发性肺动脉高压的疗效。随机试验，疗程8周，非随机治疗长达18个月。四个转介中心。24例原发性肺动脉高压患者的序贯样本。19名患者完成了这项研究。4名患者死亡，1名患者因不良反应(肺水肿)而离开研究。用便携式输液泵持续静脉注射前列环素，剂量由基线导尿术中的急性反应决定。9名患者接受了抗凝剂、口服血管扩张剂和利尿剂的治疗。以21.6U的总肺阻力为基线值开始，前列环素治疗组在8周后减少了7.9U(9.5%CI，-13.1to-2.2U；P=0.022)；而常规治疗组几乎没有变化(从20.6U降至20.4U，不显著)。在完成8周研究的10名接受前列环素治疗的患者中，有6名患者的平均肺动脉压下降到10毫米汞以上，而在常规治疗组的9名患者中，只有1名有类似的反应(P=0.057)。9名接受前列环素治疗长达18个月的患者具有持续性的血流动力学效应，尽管剂量要求随着时间的推移而增加。并发症可归因于药物输送系统。前列环素在严重的原发性肺动脉高压患者中产生显著和持续的血流动力学和系统反应，可能对一些患有这种疾病的患者的治疗有用。
To determine the efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) in primary pulmonary hypertension. Randomized trial with 8-week treatment periods and nonrandomized treatment for up to 18 months. Four referral centers. Sequential sample of 24 patients wit primary pulmonary hypertension. Nineteen patients completed the study. Four patients died and one left the study because of adverse effects (pulmonary edema). Continuous intravenous prostacyclin administered by portable infusion pump at doses determined by acute responses during baseline catheterization in ten patients. Nine patients were treated with anticoagulants, oral vasodilators, and diuretics. Starting with a baseline value for total pulmonary resistance of 21.6 units, there was a decrease of 7.9 units (9.5% CI, -13.1 to -2.2; P = 0.022) in the prostacyclin-treated group after 8 weeks; there was virtually no change in the conventional therapy group (from 20.6 to 20.4 units, not significant). Six of ten prostacyclin-treated patients who completed the 8-weeks study period had reductions in mean pulmonary artery pressure of greater than 10 mm Hg, whereas only one of nine in the conventional treatment group had a similar response (P = 0.057). Nine patients receiving prostacyclin for up to 18 months have persistent hemodynamic effects, although dose requirements have increased with time. Complications have been attributable to the drug delivery system. Prostacyclin produces substantial and sustained hemodynamic and systomatic responses in severe primary pulmonary hypertension and may be useful in the management of some patients with this disease.