摘要
目的探讨不同类型肺动脉高压患者急性血管反应试验阳性率的区别,指导临床治疗方案的选择。方法连续纳入首都医科大学附属北京朝阳医院呼吸与危重症医学科2006年10月至2015年8月行急性血管反应试验的肺动脉高压患者325例,其中动脉性肺动脉高压103例,左心疾病相关性肺动脉高压5例,肺部疾病或低氧所致肺动脉高压13例,慢性血栓栓塞性肺动脉高压209例,不明原因或多种因素所致肺动脉高压4例,均完善检查明确诊断。通过置入Swan-Ganz导管,监测患者血流动力学指标。所有患者雾化吸入伊洛前列素20μg进行血管反应试验,统计不同类型肺动脉高压患者急性血管反应试验的阳性率,并分析急性血管反应试验阳性患者的特点。结果入选患者中共38例急性血管反应试验阳性,总阳性率11.69%,其中动脉性肺动脉高压11例,阳性率10.68%,慢性血栓栓塞性肺动脉高压27例,阳性率12.92%,其他类型肺动脉高压患者未见血管反应试验阳性者。急性血管反应试验阳性的肺动脉高压患者以男性居多,世界卫生组织功能分级(WHO-FC)以Ⅱ级为主,N末端B型利钠肽原(NTproBNP)、试验前平均肺动脉压水平均低于血管反应试验阴性的患者,且心输出量及心指数均相对高于阴性者。结论肺动脉高压患者中仅有11.69%的患者急性血管反应试验阳性。动脉性肺动脉高压、慢性血栓栓塞性肺动脉高压患者血管反应试验阳性率相仿,急性血管反应试验阳性多发生于病情相对较轻的患者。
Objective Compare the positive rate of acute vascular reaction test between different types of pulmonary hypertension and guide the choice of clinical treatment. Method 325 cases of pulmonary hypertension patients accepted acute vascular reaction test.Those patients were admitted in the Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital, Capital Medical University, from October 2006 to August 2015. Enrolled patients include 103 cases of arterial pulmonary hypertension（PAH）, 5 cases with Left heart disease associated pulmonary hypertension, 13 cases caused by lung disease or hypoxic pulmonary hypertension, 209 cases of chronic thromboembolic pulmonary hypertension（CTEPH）, 4 cases of pulmonary hypertension caused by many factors. Hemodynamic parameters were monitored through Swan-Ganz catheter. All of the patients atomization inhalation 20μg iloprost to carry out vascular reaction experiment.The positive rate of acute vascular reaction test between 5 types of pulmonary hypertension were compared. Result In patients with a total of 38 patients with acute vascular response test results, the total positive rate 11.69%, 11 cases were positive in patients with PAH positive rate of 10.68%, 27 cases was positive in patients with Chronic thromboembolic pulmonary hypertension, positive rate was 12.92%. Other types of reaction test positive for pulmonary arterial hypertension patients did not see blood vessels.Patients with acute vascular reaction test positive were mainly male patients,WHO-FC nction classificationⅡ.The NT-proBNP, mean pulmonary artery pressure before the test were significantly lower compared with the negative patients, and cardiac output and cardiac index were relatively higher than the negative. Conclusion The present study shows that only about 10.69%. Arterial pulmonary hypertension, chronic thromboembolic pulmonary hypertension in patients with vascular reaction test positive rate, is similar. Acute vascular reaction test positive develops in patients with relatively mild.
作者
张向霞
李积凤
邝土光
杨媛华
ZHANG Xiang-xia;LI Ji-feng;KUANG Tu-guang;YANG Yuan-hua(Department of Respiratory and Critical Care Medicine,Shenzhen City People＇s Hospital,Guangdong Shenzhen,518020,China;Department of Respiratory Diseases,Beijing Institute of Respiratory Diseases,Beijing Key Laboratory of Respiratory and Pulmonary Circulation,Beijing Chaoyang Hospital,Beijing Capital Medical University,Beij＇ing 100020,China)
出处
《中国医刊》
CAS
2018年第10期1106-1109,共4页
Chinese Journal of Medicine
基金
国家"十二五"科技支撑课题(2012BAI05B00)
国家自然科学基金青年基金(81200041)
北京市医管局"青苗"人才计划(QML20160305)
关键词
动脉性肺动脉高压
慢性血栓栓塞性肺动脉高压
急性血管反应试验
Arterial pulmonary hypertension
Chronic thromboembolic pulmonary hypertension
Acute pulmonary vascular reaction test
