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

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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[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。

2、术后持续Lipo-PGE11-3ng/kg.min、硝普钠0.01-0.3ug/kg·min，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20mgVD1/日。出院后停前列地尔，口服西地那非依次12.5mg3/日、25mg2/日，25mg3/日，50mg2/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Combinedtreatmentwithintra

3、venousLipo-prostaglandinE1andsildenafilinpatientswithpulmonaryarterialhypertension8(PAH)secondarytoatrialseptaldefects(ASD):reportof2cases.Zhanghongchao,Yulufeng,Liyisu,Lilingke,Wanshijie.Thecardiacsurgerydepartment,thegeneralairforcehospital,Beijing100036BACKGROUNDANDOBJECTIVE:Toreporttheexperienc

4、eobtainedfromacombinedtreatmentprogramwithintravenous(i.v)lipo-prostaglandinE1（Lipo-PGE1,Alprostadil,BeijingTaidepharmaceuticalco.LTD.）andoralsildenafilinpatientswithseverepulmonaryhypertensionsecondarytoatrialseptaldefects(ASD)duringperi-operation.PATIENTSANDMETHOD:ThetwoASDpatientswerediagnosedPA

5、Hbyrightheartcatheterization.Theirpulmonarypressurealmostequaltoarterybloodpressure.Thechangesofclinicalmanifestation(NYHAfunctionalclass),heartrate,echocardiography(includingtoestimatepulmonarypressure)wereevaluatedbeforeandaftertreatment.Thetreatmentprogramwasintravenous(i.v)lipo-prostaglandinE12

6、0ugdaily2weeks,and2-4ng/kg.minfromoperationto4thsday.Then,sildenafilwasaddedtothetreatmentInitialsildenafildosewas12.5mg2timesdailyforaweek.Soinsuccession12.5mg3timesdaily,25mg2times,825mg3times,50mg2timesdailyrespectivelyaweekandanotherintravenous(i.v)lipo-prostaglandinE120ugdaily2weeks.RESULTS:By

7、theendoftheprogramthesymptomsofdyspneaweredisappeared.TheircardiacfunctionconvertedtoclassI(previouslyclassⅡandIII).Thesystolicpulmonaryarterypressuredecreasedin2patients(averagereduction47%).Therightventri