The case for treatment of selected patients with primary pulmonary hypertension.
The case for treatment of selected patients with primary pulmonary hypertension.
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DOI：
10.1164/arrd.1986.134.2.342
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发表时间：
1986-08
期刊：
影响因子：
--
通讯作者：
J. Reeves;B. Groves;D. Turkevich
中科院分区：
文献类型：
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作者：
J. Reeves;B. Groves;D. Turkevich
肺血管扩张剂治疗原发性肺动脉高压存在争议。有些病人受益了，有些则没有。为了阐明这一点，我们回顾了117例急性血管扩张剂激发患者的已发表报告，发现53例患者的肺血管阻力降低了30%或更多。钙拮抗剂（n = 46）、肼苯哒嗪（n = 23）和二氮嗪（n = 18）在抵抗方面的急性减少大致相当（分别为30%、35%、32%），但卡托普利（n = 17）的反应较差（-7%）。报告表明，慢性治疗（3个月或更长时间）仅使64例患者中的4例（6%）受益，其急性耐药性降低小于30%。然而，当抵抗力急剧下降超过30%时，53名患者中有33名（62%）在治疗后有所改善。在5例接受多次导管插入术的患者中，随访期间（10至48个月）持续改善。除卡托普利外，所用药物均能降低耐药性，因此选择何种药物应根据避免副作用而定。长期的益处从来都不是确定的，但是选择急性血管扩张反应活跃的患者可以预测慢性血管扩张治疗的益处。
The treatment of primary pulmonary hypertension with pulmonary vasodilator agents is controversial. Some patients have benefited, while others have not. To shed light on the mater we reviewed published reports of 117 patients having acute vasodilator challenge and found that 53 reduced their pulmonary vascular resistance by 30% or more. Calcium antagonists (n = 46), hydralazine (n = 23), and diazoxide (n = 18) gave approximately equivalent acute reductions in resistance (30%, 35%, 32%, respectively), but captopril (n = 17) gave a poor response (-7%). The reports indicated that chronic treatment (3 months or longer) benefited only 4 of 64 patients (6%) having acute reduction in resistances of less than 30%. However, when resistance was lowered acutely by more than 30%, 33 of 53 patients (62%) improved with treatment. In 5 patients having multiple catheterization, improvement was sustained for the duration of follow-up (10 to 48 months). Except for captopril, the agents employed gave similar reductions in resistance, and perhaps the choice should be determined by avoidance of side-effects. Long-term benefit is never certain, but selecting patients with brisk acute vasodilator responses may predict the benefit from chronic vasodilator treatment.