Continuous intravenous epoprostenol for chronic thromboembolic pulmonary hypertension
Continuous intravenous epoprostenol for chronic thromboembolic pulmonary hypertension
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DOI：
10.1183/09031936.04.00020004
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发表时间：
2004-04-01
影响因子：
24.3
通讯作者：
Rubin, LJ
中科院分区：
文献类型：
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作者：
Bresser, P;Fedullo, PF;Rubin, LJ
慢性血栓栓塞性肺动脉高压（CTEPH）的病理生理学结果表明，继发性小血管动脉病可能导致这些患者中观察到的血流动力学损害。据推测，这一因素的血管阻力升高可能是响应于连续静脉依前列醇therapy. Retroperitoneal，临床和血液动力学反应，连续静脉依前列醇进行了评估，9 CTEPH患者随后接受肺血栓动脉内膜切除术（PTE）。在开始使用依前列醇之前、使用依前列醇期间、PTE之前和PTE之后，测定了心血管性血液动力学。6名患者在PTE之前接受了2-26个月的治疗，临床稳定或改善，肺血管阻力（PVR）平均降低28%（中位数33%，范围0-46%）。治疗3-9个月的3例患者在依前列醇给药期间发生临床恶化，2例患者的PVR显著增加。随后的PTE导致心脏指数、平均肺动脉压和总肺阻力的显著改善。总之，选定的慢性血栓栓塞性肺动脉高压患者在肺血栓内膜切除术前持续静脉依前列醇治疗可能在临床和血液动力学方面受益。预测有益反应的因素，以及这种干预是否影响与肺血栓动脉内膜切除术相关的发病率或死亡率，仍有待确定。
Pathophysiological findings in chronic thromboembolic pulmonary hypertension (CTEPH) have suggested that a secondary small vessel arteriopathy may contribute to the haemodynamic impairment observed in these patients. It was hypothesised that this element of the elevated vascular resistance may be responsive to continuous intravenous epoprostenol therapy.Retrospectively, the clinical and haemodynamic responses to continuous intravenous epoprostenol were evaluated in nine CTEPH patients who subsequently underwent pulmonary thromboendarterectomy (PTE). Cardiopulmonary haemodyamics were determined prior to the initiation of epoprostenol, while on epoprostenol, prior to PTE, and after PTE.Six patients, treated for 2-26 months prior to PTE, experienced either clinical stability or improvement that was associated with a mean reduction in pulmonary vascular resistance (PVR) of 28% (median 33%,,, range 0-46%). Three patients, treated for 3-9 months, experienced clinical deterioration during epoprostenol administration, with a significant increase in PVR in two patients. Subsequent PTE resulted in a highly significant improvement of cardiac index, mean pulmonary artery pressure and total pulmonary resistance.To conclude, selected patients with chronic thromboembolic pulmonary hypertension may benefit clinically and haemodynamically from continuous intravenous epoprostenol treatment prior to pulmonary thromboendarterectomy. Factors predictive of a beneficial response, and whether this intervention influences either morbidity or mortality associated with pulmonary thromboendarterectomy, remain to be established.