我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

先天性心脏病重度肺动脉高压对腺苷的急性反应

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第2期
页码:
241-244
栏目:
临床研究
出版日期:
2010-12-10

文章信息/Info

Title:
Acute hemodynamic responses to adenosine in patients with congenital heart disease and severe pulmonary hypertension
作者:
张端珍; 朱鲜阳; 崔春生; 张坡; 盛晓棠; 王琦光
沈阳军区总医院先心病内科，辽宁 沈阳 110016
Author(s):
ZHANG Duan-zhen;  ZHU Xian-yang;  CUI Chun-Sheng;  ZHANG Po;  SHENG Xiao-tang;  WANG Qi-guang
Department of Congenital Heart Disease, General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China
关键词:
心脏病; 先天性; 肺动脉高压; 腺苷; 血流动力学; 急性肺血管扩张试验
Keywords:
congenital heart defect;  pulmonary arterial hypertension;  adenosine;  hemodynamics;  acute vasodilator test
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的: 探讨先天性心脏病（CHD）并发重度肺动脉高压（PAH）患者对腺苷的急性血流动力学反应。方法： 对25例CHD并发严重PAH患者采用腺苷进行急性肺血管扩张试验，检测其血流动力学指标变化。结果： 25例患者中，仅7例患者达到最大剂量无不良反应。给予腺苷后，肺动脉压力和主动脉压力均显著降低（P<0.05），股动脉血氧饱和度，肺血管阻力，肺循环/体循环血流量比值，肺动脉/主动脉平均压比值，肺血管阻力/体循环阻力比值（Rp/Rs）均无明显变化。没有患者肺动脉平均压降至40 mmHg以下。12例患者肺血管阻力和Rp/Rs降低10%以上，与另外13例患者比较，二者在年龄，肺动脉压力，肺动脉/主动脉平均压比值，肺循环/体循环血流量比值，肺血管阻力和Rp/Rs等方面均无明显差异。结论： 在CHD并发重度PAH患者中，采用腺苷进行急性肺血管扩张试验可引起肺动脉和体循环压力同步降低，而对肺血管阻力无明显影响。
Abstract:
AIM: To investigate the acute hemodynamic responses to adenosine in patients with congenital heart disease (CHD) and severe pulmonary arterial hypertension (PAH). METHODS: Twenty-five patients with severe PAH secondary to left-to-right shunt CHDs underwent acute vasodilator test using IV adenosine infusion. Hemodynamic parameters were detected and analyzed. RESULTS: Only seven patients received the maximal dose 200 μg/(kg·min) of adenosine infusion without adverse effects. The tolerance dose of adenosine was (145±27) μg/(kg·min) in the other 18 patients. Both pulmonary artery pressure and systemic arterial pressure significantly decreased (P<0.05) after administration of adenosine, whereas the oxygen saturation of femoral artery blood, pulmonary vascular resistance, pulmonary-to-systemic flow ratio, mean pulmonary-to-aortic pressure and pulmonary-to-systemic vascular resistance ratio showed no significant changes. Mean pulmonary arterial pressure was >40 mmHg in all study patients. No significant difference was observed in the age and baseline hemodynamics between the patients with decreasing pulmonary vascular resistance and mean pulmonary-to-aortic pressure ratio >10% and the patients without these changes. CONCLUSION: Administration of adenosine induces synchronous decreases in pulmonary artery pressure and systemic arterial pressure but exerts no effect on pulmonary vascular resistance in patients with CHD and severe PAH.

参考文献/References

[1]Apostolopoulou SC, Manginas A, Cokkinos DV, et al. Long-term oral bosentan treatment in patients with pulmonary arterial hypertension related to congenital heart disease: a 2-year study［J］. Heart, 2007, 93(3):350-354.

[2]Voswinckel R, Enke B, Reichenberger F, et al. Favorable effects of inhaled treprostinil in severe pulmonary hypertension: results from randomized controlled pilot studies［J］. J Am Coll Cardiol, 2006, 48(8):1672-1681.

[3]Pepke-Zaba J, Gilbert C, Collings L, et al. Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension［J］. Chest, 2008, 133(1):183-189.

[4]Jing ZC, Jiang X, Han ZY, et al. Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension［J］. Eur Respir J, 2009, 33(6):1354-1360.

[5]Opitz CF, Wensel R, Bettmann M, et al. Assessment of the vasodilator response in primary pulmonary hypertension. Comparing prostacyclin and iloprost administered by either infusion or inhalation［J］. Eur H eart J, 2003, 24(4):356-365.

[6] Galiè N, Torbicki A, Barst R, et al. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology［J］. Eur Heart J, 2004, 25(24):2243-2278.

[7]Limsuwan A, Khosithseth A, Wanichkul S, et al. Aerosolized iloprost for pulmonary vasoreactivity testing in children with long-standing pulmonary hypertension related to congenital heart disease［J］. Catheter Cardiovasc Interv, 2009, 73(1):98-104.

[8]Barst RJ, Maislin G, Fishman AP. Vasodilator therapy for primary pulmonary hypertension in children［J］. Circulation, 1999, 99: (9)1197-1208.

[9]Sitbon O, Humbert M, Jagot JL, et al. Inhaled nitric oxide as a screening agent for safely identifying responders to oral calcium-channel blockers in primary pulmonary hypertension［J］. Eur Respir J, 1998, 12(2):265-270.

[10]Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines［J］. Chest, 2007, 131(6):1917-1928.

备注/Memo

备注/Memo:
收稿日期：2010-03-16.通讯作者：朱鲜阳，主任医师，主要从事结构性心脏病影像诊断和介入治疗研究 Email：xyangz@yahoo.com.cn 作者简介：张端珍，主治医师，博士Email：meichengzhang123@163.com
更新日期/Last Update: 2010-12-10