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目的探讨雾化吸入伊洛前列素进行急性血管扩张试验的价值。方法研究对象为2007年2月至2008年5月在广东省心血管病研究所住院的50例先天性心脏病合并肺动脉高压患儿,对所有患儿进行左右心导管检查,之后肺动脉内注射酚妥拉明或雾化吸入伊洛前列素进行急性血管扩张试验,试验后重复左右心导管检查。根据Fick公式计算血流动力学参数。综合判断肺动脉高压性质,将患儿分成两组:动力组和梗阻组。动力组患儿进行手术治疗,术后定期随访并修正术前诊断。结果酚妥拉明会显著增高受试者的心率,而伊洛前列素对心率的影响较轻微;酚妥拉明和伊洛前列素都能够降低平均肺动脉压力和肺血管阻力,升高肺循环血流量;酚妥拉明同时会降低平均主动脉压力和体循环阻力,升高体循环血流量,而伊洛前列素对体循环没有明显的影响。在使用伊洛前列素的急性血管扩张试验中,平均肺动脉压力、肺血管阻力/体循环阻力和肺循环血流量/体循环血流量等参数的变化在动力组和梗阻组中差异无统计学意义(P值分别为0.016、0.024和0.030)。而使用酚妥拉明的急性血管扩张试验中,平均肺动脉压力和肺血管阻力两项参数的变化在动力组和梗阻组中差异有统计学意义(P值分别为0.017和0.004)。结论在先天性心脏病合并肺动脉高压的患儿中,使用酚妥拉明或伊洛前列素进行急性血管扩张试验都能够有效区分动力性与梗阻性肺动脉高压。酚妥拉明用药前后,肺循环和体循环的压力、阻力和血流量都有明显变化。而伊洛前列素雾化吸入以影响肺循环为主,可以保持相对平稳的血流动力学,在安全性上优于酚妥拉明。
Objective To investigate the value of inhalation of iloprost for acute vasodilatation test. Methods The subjects were 50 children with congenital heart disease complicated with pulmonary hypertension who were hospitalized in Guangdong Provincial Institute of Cardiology from February 2007 to May 2008. Left and right cardiac catheterization was performed on all children. After the pulmonary artery injection of phenol Toramin or nebulized iloprost for acute vasodilation test, after repeated cardiac catheterization test. The hemodynamic parameters were calculated according to Fick’s formula. Comprehensive judgment of the nature of pulmonary hypertension, the children were divided into two groups: power group and obstruction group. Power group children underwent surgical treatment, regular follow-up and revision of preoperative diagnosis. Results Phentolamine significantly increased the heart rate of the subjects, while the effect of iloprost on heart rate was slight. Both phentolamine and iloprost decreased mean pulmonary artery pressure and pulmonary vascular resistance, and increased pulmonary blood flow Phentolamine also reduces mean aortic pressure and systemic resistance, increases systemic blood flow, and iloprost has no significant effect on systemic circulation. In the case of iloprost-induced acute vasodilatation, changes in parameters such as mean pulmonary artery pressure, pulmonary vascular resistance / systemic resistance, and pulmonary circulation / systemic blood flow were not statistically different between the power group and the obstruction group (P value 0.016, 0.024 and 0.030, respectively). The use of phentolamine in the acute vasodilatation test, the average pulmonary artery pressure and pulmonary vascular resistance changes in the two parameters in the power group and obstruction group, the difference was statistically significant (P values were 0.017 and 0.004). Conclusions In children with congenital heart disease and pulmonary hypertension, the use of phentolamine or iloprost for acute vasodilation can effectively distinguish between motility and obstructive pulmonary hypertension. Phentolamine medication before and after the pulmonary circulation and systemic pressure, resistance and blood flow have significant changes. The iloprost inhalation to affect the pulmonary circulation, can maintain a relatively stable hemodynamics, the safety is superior to phentolamine.