【摘要】 目的总结分析曲前列尼尔对心脏移植患者肺动脉高压的治疗效果。方法回顾性分析15例术前合并肺动脉高压心脏移植患者术后使用曲前列尼尔降肺动脉压力的临床资料,比较使用曲前列尼尔前后血流动力学[有创动脉收缩压(SBP)、心率(HR)、中心静脉压(CVP)、乳酸(Lac)和尿量、肺动脉收缩压(PASP)、三尖瓣环收缩期位移(TAPSE)和血肌酐(Cr)、谷丙转氨酶(ALT)、总胆红素(TIBL)和血小板计数(PLT)]的变化,同时记录使用过程中出现的不良反应。结果使用前后SBP、HR无明显变化,CVP在用后16 h开始与用前比差异有统计学意义(用后16 h,P=0.00;用后24 h,P=0.00;用后48 h,P=0.00;用后72 h,P=0.00);Lac从用后16 h开始与用前比较差异有统计学意义(用后16 h,P=0.04;用后24 h,P=0.04;用后48 h,P=0.02;用后72 h,P=0.01);尿量在用后16 h至48 h与用前比较差异有统计学意义(用后16 h,P=0.02;用后24 h,P=0.005;用后48 h,P=0.006), PASP在用后1 d开始与用前比较差异有统计学意义(用后1 d,P=0.00;用后2 d,P=0.00;用后3 d,P=0.00);TAPSE在用后2 d和3 d与用前比较差异有统计学意义(用后2 d,P=0.00;用后3 d,P=0.00)。Cr在用后2 d开始与用前比较差异有统计学意义(用后2 d,P=0.01;用后3 d,P=0.00);TIBL在用后1 d开始与用前比较差异有统计学意义(用后1 d,P=0.01;用后2 d,P=0.03;用后3 d,P=0.006),ALT、PLT使用前后差异无统计学意义(P>0.05)。在使用过程中4例(26.7%)患者出现颜面及胸部皮肤潮红;1例(6.7%)患者出现明显血压下降,1例(6.7%)患者出现严重恶心呕吐。结论曲前列尼尔可有效降低心脏移植患者的肺动脉压力和中心静脉压,改善右心收缩功能,改善灌注,改善肝肾功能,但在使用过程中需注意其不良反应。更多还原

【Abstract】 Objective To summarize the clinical effect of Treprostinil on pulmonary hypertension in heart transplant patients. Methods The clinical data of 15 heart transplant cases with pulmonary hypertension treated with Treprostinil after operation were retrospectively analyzed. The hemodynamic indexes, systolic blood pressure(SBP), heart rate(HR), central venous pressure(CVP), lactic acid(Lac), urine volume(ml/h), and pulmonary artery systolic pressure(PASP), tricuspid annular plane systolic excursion(TAPSE), serum creatinine(Cr umol/L), alanine aminotransferase(ALT U/L), total bilirubin(TIBL umol/L) and the platelet count(PLT), were compared. The side effects were also recorded. Results There was no significant changes in SBP, HR, ALT or PLT between before and after treatment. There were significant changes in CVP since 16 h after treatment(16 h, P=0.00; 24 h, P=0.00; 48 h, P=0.00; 72 h, P=0.00); so were in Lac(16 h, P=0.04; 24 h, P=0.04; 48 h, P=0.02; 72 h, P=0.01) and urine volume(16 h, P=0.02; 24 h, P=0.005; 48 h, P=0.006). There were significant changes in PASP since 1 day after treatment(1 d, P=0.00; 2 d, P=0.00; 3 d, P=0.00). There were significant changes in TAPSE 2 and 3 days after treatment(2 d, P=0.00; 3 d, P=0.00); so were in Cr(2 d, P=0.01; 3 d, P=0.00). There were significant changes in TIBL since 1 day after treatment(1 d, P=0.01; 2 d, P=0.03; 3 d, P=0.006). Face, chest and skin flush were observed in 4 cases(26.7%); blood pressure reduction in 1 case(6.7%); and severe nausea and vomiting in 1 case(6.7%). Conclusion Treprostinil can effectively reduce pulmonary artery pressure and central venous pressure in heart transplant patients, and improve the systolic function of right ventricle, perfusion, and liver and kidney function. But should pay attention to its side effects.更多还原