前列地尔联合西地那非在房缺重度肺动脉高压的临床应用

1、前列地尔联合西地那非在房缺重度肺动脉高压的临床应用前列地尔联合西地那非在房缺重度肺动脉高压的临床应用摘要 本文总结了前列地尔联合西地那非控制两例房缺合并严重肺动脉高压（PAH）的疗效。病人与方法：两例患者均未青年女性患者，有心功能不全及劳力性紫绀，心导管检查PAP几乎与动脉压相等，前列腺素降压实验无反应，影响学检查肺动脉及右心系统均表现扩张与肥厚，由于 摘要 本文总结了前列地尔联合西地那非控制两例房缺合并严重肺动脉高压（PAH）的疗效。病人与方法：两例患者均未青年女性患者，有心功能不全及劳力性紫绀，心导管检查PAP几乎与动脉压相等，前列腺素降压实验无反应，影响学检查肺动脉及右心系统均表现扩张与

2、肥厚，由于考虑患者年龄及静息状态血气，在充分准备下进行了手术处里，术前巯甲丙脯酸6.25mg口服2/日，西地那非12.5mg口服2/日，前列地尔（前列腺素E1脂微球制剂，Lipo-PGE1,北京泰德公司）40mg静滴1/日，半月后于全麻体外循环（ECC）心脏不停跳下行房缺修补术，术中前列地尔持续泵入。术后持续Lipo-PGE11-3ng/kg.min、硝普钠0.01-0.3ug/kgmin，术后第四天开始服用西地那非12.5mg2/日，巯甲丙脯酸12.5mg2/日，前列地尔20mg VD 1/日。出院后停前列地尔，口服西地那非依次12.5mg 3/日、25 mg2/日，25mg 3/日，50m

3、g 2/日各1周，最后Lipo-PGE120ug 静滴1/日 10天，用药期间多次出现头痛，随访5月心功能I 级(NYHA)已经恢复原办公室工作。结论：Lipo-PGE1和西地那非控制先心病合并严重（PAH）的理想方案。 关键词：前列地尔 西地那非 房间隔缺损 肺动脉高压 Combined treatment with intravenous Lipo-prostaglandin E1 and sildenafil in patients with pulmonary arterial hypertension (PAH) secondary to atrial septal defects(

4、ASD): report of 2cases. Zhang hongchao, Yu lufeng, Li yisu, Li lingke, Wan shijie.The cardiac surgery department,the general airforce hospital,Beijing 100036 BACKGROUND AND OBJECTIVE: To report the experience obtained from a combined treatment program with intravenous (i.v) lipo-prostaglandin E1（Lip

5、o-PGE1,Alprostadil, Beijing Taide pharmaceutical co. LTD.）and oral sildenafil in patients with severe pulmonary hypertension secondary to atrial septal defects(ASD) during peri-operation. PATIENTS AND METHOD: The two ASD patients were diagnosed PAH by right heart catheterization.Their pulmonary pres

6、sure almost equal to artery blood pressure. The changes of clinical manifestation (NYHA functional class), heart rate, echocardiography (including to estimate pulmonary pressure) were evaluated before and after treatment. The treatment program was intravenous (i.v) lipo-prostaglandin E1 20ug daily 2

7、 weeks,and 2-4ng/kg.min from operation to 4ths day.Then, sildenafil was added to the treatment Initial sildenafil dose was 12.5 mg 2 times daily for a week. So in succession 12.5 mg 3 times daily, 25 mg 2 times, 25 mg 3 times,50 mg 2 times daily respectively a week and another intravenous (i.v) lipo

8、-prostaglandin E1 20ug daily 2 weeks. RESULTS:By the end of the program the symptoms of dyspnea were disappeared. Their cardiac function converted to class I (previously class and III). The systolic pulmonary artery pressure decreased in 2 patients (average reduction 47%). The right ventricular were

9、 diminished apparently. The only side effect of sildenafil seen was mild headache.They all recovered to their original work positions when the follow-up were 4,6months.CONCLUSIONS: Our experience supports the value of our program in the treatment of PAH.It is useful for rescuing patients who has sev

10、ere pulmonary hypertension secondary to congenital heart disease. Furthermore,it is easy to carry out for out-patients. Keyword: 25cmH2O给于安定镇静加酚妥拉明5mg缓慢静推，效果良好。术后第四天开始服用西地那非12.5mg2/日，巯甲丙脯酸12.5mg2/日，前列地尔20mg VD 1/日。有主诉头晕恶心，住院期间主诉发音轻松，声嘶无明显改变，出院复查胸片见心影及肺动脉段略有缩小，超声测量右心室302865 mm3，房间隔无分流，PAP估测约17mmHg，出院

11、后停前列地尔，口服西地那非依次12.5mg 3/日、25 mg2/日，25mg 3/日，50mg 2/日各1周，最后Lipo-PGE120ug 静滴1/日 10天，用药期间多次出现头痛，对症处理易缓解，出院后早期病人有间断心慌、气短，但活动能力明显提高，无呕吐、头晕等情况。随访10月，心功能由级恢复到I 级(NYHA)，已经可从事办公室文员工作。 病例2：女，27岁，主诉：“劳力性心慌气短10年余”入院，稍有劳累即有紫绀，无蹲踞。查体：无明显紫绀，心前区无杂音，P2高度亢进。右心导管105/55（71）mmHg，肺动脉中度扩张，前列腺素降压无反应，肺动脉阻力为5.6WOODS；超声：肺主干44mm，右支22mm，左干21mm，右心室舒张末大小为425469mm3，中央型房缺，双向分流以左向右分流为主，肺动脉瓣、三尖瓣返流，估测PAP收缩压67mmHg，胸片：右心扩大，肺动脉段严重突出，双肺血管呈残根样改变。ECG：右心肥厚。静息状态下上下肢动脉血气氧分压均大于85 mmHg。为术期处理及手术方法与例1方案相同。术中见肺动脉主干32mm，左肺动脉22mm，右肺动脉22mm，房缺中央型2.53.4 cm2，术中PAP（平均压），ECC前52mmHg与主动脉比为（P/A0.71），ECC后PAP为50mmHg（P/A为0.75），给