肺高血圧症における prostaglandin E_1 の肺循環および血液ガスにおよぼす影響
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The effects of prostaglandin E_1 (PGE_1)on pulmonary circulation and blood gas was studied in 25 patients with pulmonary hypertension due to mitral valve disease and congestive cardiomyopathy. These patients were divided into two groups, i. e. H-group and L-group. Mean pulmonary artery pressure (mPAP) in the former and in the latter was more than 25 mmHg and less than 25 mmHg, respectively. It was found that the intravenous administration of 0.08 γ/kg/min of PGE_1 in H-group decreased mPAP (P<0.001), mean pulmonary arterial wedge pressure (mPAWP) (P<0.01) and pulmonary arteriolar resistance (PAR) (P<0.005), and increased cardiac index (CI) (P<0.001). Arterial oxygen tension (Pao_2) and alveolar-arterial oxygen tension difference (A-aDo_2) remained unchanged. On the other hand, the administration of PGEI in L-group decreased mPAP (P<0.005) and PAR (P<0.02), whereas mPAWP remained unchanged and CI was increased (P<0.001). A de crease in Pao_2 (P<0.001) and an increase in A-aDo_2 (P<O.02) were also observed. The percentage change of mPAP (△mPAP) induced by PGE_1 indicated a significant inverse correlation with mPAP on the control condition (r=-0.61, P<0.005). The percentage change of CI(△CI) showed a significant inverse correlation with △mPAP (r=-0.48, P<0.02) and △mPAP showed a significant inverse correlation with A-aD02 on control condition (r=-0.51, P<0.01). These findings indicated that the intravenous administration of PGE_1 caused active vasodilation iri pulmonary vascular bed in patients with postcapillary pulmonary hypertension, and that the improvement of pulmonary circulation was observed only in patients with severe pulmonary hypertension, although no remarkable change was detected in patients with moderate and mild pulmonary hypertension. The lowering of mPAP was not accompanied by the worsening of blood gas and gas exchange in the lung. In addition, it was revealed that the change of pulmonary hemodynamics caused by PGE_1 improved ventilation-perfusion ratio and accordingly PGE_1 had favorable effects on blood gas and pulmonary gas exchange in severe pulmonary hypertension.
- 神戸大学の論文