摘要
目的 探讨儿童特发性肺动脉高压（IPAH）患者急性肺血管扩张试验的指征、方法学.方法 2009年10月到2011年6月收治的WHO心功能Ⅱ～Ⅲ级的IPAH患儿参与了该项研究.在右心导管检查获取了基线血流动力学资料后,从中心静脉泵入腺苷,起始剂量为50 μg/（kg·min）,每2分钟递增25 μg/（kg·min）,直至达到最大剂量250μg/（kg·min）或达到阳性反应.结果 15例IPAH患儿纳入了该项研究,平均年龄为6.3岁,平均肺动脉压（mPAP）为（67.1±15.9）mm Hg （1 mm Hg =0.133 kPa）,肺毛细血管楔压（PCWP）为（9.7±2.9） mm Hg,肺血管阻力指数（PVRI）为（17.9±7.5） Wood U·m2.在急性肺血管扩张试验中,3例mPAP下降幅度超过10 mm Hg,并且绝对值≤40 mm Hg,为阳性反应；另外12例为阴性反应.15例中有5例在试验中出现不良反应,包括胸闷不适（n=1）、体循环低血压（n=3）、心动过缓（n=1）.停用腺苷后30～60 s,上述不良反应均迅速消失.结论 静脉用腺苷是一种安全、有效的肺血管扩张剂,可作为儿童IPAH患者急性肺血管扩张试验的试验药物.
Objective The assessment of pulmonary vascular reactivity plays an important role in the management of idiopathic pulmonary arterial hypertension （IPAH）.The aim of this study was to explore the indications and methodology of pulmonary vasodilator testing in children with IPAH.Methods From October 2009 to June 2011,a cohort of pediatric patients with IPAH in WHO functional classes Ⅱ to Ⅲ were enrolled in the study.Right heart catheterization was performed in all patients.After baseline hemodynamics were obtained,adenosine infusions were started at a dose of 50 μg/（ kg · min）,increased by 25 μg/（kg · min） at 2 min intervals to a maximum of 250 μg/（kg · min） or until a positive acute response.Results A total of 15 patients with IPAH were enrolled in the study.The mean age of the patients was 6.3 yrs.Mean pulmonary artery pressure （mPAP） was （67.1 ± 15.9） mm Hg.Pulmonary capillary wedge pressure （PCWP） was （9.7 ±2.9） mm Hg.Pulmonary vascular resistance index （PVRI）was （17.9 ±7.5） Wood U · m2.Three patients were responders,defined as a fall in mPAP of at least 10 mm Hg to a pressure level of 40 mm Hg or lower.Twelve patients were nonresponders according to the same criteria.Five out of the 15 patients experienced adverse effects,including chest discomfort （n =1 ）,systemic hypotension （ n =3 ） and bradycardia （ n =1 ）.All side effects abated within 30-60 s of the discontinuation of the adenosine infusion.Conclusion Adenosine is an effective vasodilator in children with IPAH and can be used for safe and rapid assessment of vasodilator reserve in these patients.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2011年第12期886-889,共4页
Chinese Journal of Pediatrics
