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【文摘发布】儿童肺动脉高压吸入伊洛前列素可
D. Dunbar Ivy, MD*,1,*, Aimee K. Doran, CPNP*,3, Kelly J. Smith, MD, George B. Mallory, Jr, MD, Maurice Beghetti, MD, Robyn J. Barst, MD,4, Daniela Brady, RN, Yuk Law, MD||, Donna Parker, RRT*, Lori Claussen, RN* and Steven H. Abman, MD*,2
* The Pulmonary Hypertension Program and Pediatric Heart Lung Center, Department of Pediatrics, The University of Colorado School of Medicine and The Children’s Hospital, Denver, Colorado
Pediatric Pulmonology, Texas Children’s Hospital, and Baylor University School of Medicine, Houston Texas
Pediatric Cardiology, Hospital of the University of Geneva and Children’s Hospital of Geneva, Geneva, Switzerland
Columbia University College of Physicians and Surgeons and New York Pre***yterian Hospital, New York, New York
|| Children’s Hospital & Regional Medical Center, Department of Pediatrics, University of Washington, Seattle, Washington.
Objectives: This study investigated the short- and long-term outcome of children with pulmonary arterial hypertension (PAH) treated with inhaled iloprost.
Background: Inhaled iloprost has been approved for the treatment of adults with PAH, but little is known about the effects in children with PAH.
Methods: We evaluated the acute effects of inhaled iloprost on hemodynamic status and lung function and the response to long-term therapy in 22 children (range 4.5 to 17.7 years) with PAH (idiopathic, n = 12; congenital heart disease, n = 10). Cardiac catheterization, standard lung function testing before and after iloprost inhalation, 6-min walk test, World Health Organization functional class, and hemodynamic parameters were monitored.
Results: Acute administration of inhaled iloprost lowered mean pulmonary artery pressure equivalent to the response to inhaled nitric oxide with oxygen. Acute iloprost inhalation reduced forced expiratory volume in 1 s and mid-volume forced expiratory flow by 5% and 10%, respectively, consistent with acute bronchoconstriction. At 6 months, functional class improved in 35%, decreased in 15%, and remained unchanged in 50% of children. Sixty-four percent of patients continued receiving long-term iloprost therapy, 36% stopped iloprost, due to lower airway reactivity, clinical deterioration, or death. In 9 patients on chronic intravenous prostanoids, 8 transitioned from intravenous prostanoids to inhaled iloprost, which continued during follow-up.
Conclusions: Inhaled iloprost caused sustained functional improvement in some children with PAH, although inhaled iloprost occasionally induced bronchoconstriction. Most patients tolerated the transition from intravenous to inhaled prostanoid therapy. Clinical deterioration, side effects, and poor compliance, owing to the frequency of treatments, could limit chronic treatment in children.
J Am Coll Cardiol 2008 51: 161-169.
http://content.onlinejacc.org/cgi/content/abstract/51/2/161 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Short- and Long-Term Effects of Inhaled Iloprost Therapy in Children With Pulmonary Arterial Hypertension
吸入伊洛前列素治疗对肺动脉高压儿童的短期和长期作用
Objectives: This study investigated the short- and long-term outcome of children with pulmonary arterial hypertension (PAH) treated with inhaled iloprost.
目的：这项研究观察了吸入伊洛前列素治疗对肺动脉高压（PAH）儿童的短期和长期作用
Background: Inhaled iloprost has been approved for the treatment of adults with PAH, but little is known about the effects in children with PAH.
背景：吸入伊洛前列素被证实可用于治疗成人PAH，但其对儿童PAH的作用尚不清楚。
Methods: We evaluated the acute effects of inhaled iloprost on hemodynamic status and lung function and the response to long-term therapy in 22 children (range 4.5 to 17.7 years) with PAH (idiopathic, n = 12; congenital heart disease, n = 10). Cardiac catheterization, standard lung function testing before and after iloprost inhalation, 6-min walk test, World Health Organization functional class, and hemodynamic parameters were monitored.
方法：我们评价了吸入伊洛前列素用于22例PAH儿童（4.5-17.7岁，原发性12例、充血性心力衰竭10例）对血流动力学状态和肺功能的急性作用及其长期疗效。研究监测了吸入前后的心导管检查、标准肺功能检查，6分钟步行实验、世界卫生组织功能分级和血流动力学指标。
Results: Acute administration of inhaled iloprost lowered mean pulmonary artery pressure equivalent to the response to inhaled nitric oxide with oxygen. Acute iloprost inhalation reduced forced expiratory volume in 1 s and mid-volume forced expiratory flow by 5% and 10%, respectively, consistent with acute bronchoconstriction. At 6 months, functional class improved in 35%, decreased in 15%, and remained unchanged in 50% of children. Sixty-four percent of patients continued receiving long-term iloprost therapy, 36% stopped iloprost, due to lower airway reactivity, clinical deterioration, or death. In 9 patients on chronic intravenous prostanoids, 8 transitioned from intravenous prostanoids to inhaled iloprost, which continued during follow-up.
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作者:admin@医学,生命科学 2011-09-02 17:15
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