A Case of Severe Pulmonary Hypertension Effectively Treated with Amrinone

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• A case of severe pulmonary hypertension effectively treated with amrinone is reported. A 66-year-old man was admitted to our hospital with a diagnosis of bladder tumor, and antineoplastic chemotherapy with cisplatin, methotrexate, vinblastine and pirarubicin was initiated. Two weeks after start of the chemotherapy, pancytopenia developed. Following administration of granulocyte colony stimulating factor, chemotherapy was discontinued. One month after admission, acute respiratory failure developed and tracheal intubation was performed. The patient was admitted to the ICU with severe hypoxemia and hypercapnea (PaO2 48.2mmHg, PaCO2 49.7mmHg) and was placed on mechanical ventilation with 2cm H2O of positive endexpiratory pressure and FIO2=1.0. Although blood pressure and heart rate were stable, pulmonary hypertention (mean pulmonary arterial pressure 30mmHg) and interstitial pneumonia were present. Despite administration of antibiotics, steroids and urinastatin, the pulmonary hypertention was progressed. Dobutamine was administered, but the pulmonary hypertension did not improve. Amrinone was then administered intravenously in addition to dobutamine. Pulmonary arterial pressure and pulmonary vascular resistance decreased gradually without any change in pulmonary capillary wedge pressure or cardiac output, and both oxygenation and CO2 elimination improved following amrinone administration. Amrinone induces direct pulmonary vasodilatation and has positive inotropic and afterload-reducing effects. In the present case, amrinone improved pulmonary hypertension, oxygenation and CO2 elimination probably via direct pulmonary vasodilatation.

• 一般社団法人 日本集中治療医学会の論文

一般社団法人 日本集中治療医学会 | 論文

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