米力农对肺动脉高压的治疗作用及其机制探究
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摘要
目的:观察不同剂量米力农对肺动脉高压患者的治疗作用,在此基础上探讨米力农的降低肺动脉高压的机制。方法:测定患者给药后平均体动脉压、肺动脉压、肺血管阻力、血清中肾素、血管紧张素、醛固酮水平和6分钟步行步数等指标。结果:与对照组相比3组患者肺动脉压力、平均体动脉压、肺血管阻力显著降低(P<0.01或0.05),同时能够显著性的提高6分钟步行步数(P<0.01或0.05)。高剂量组要明显优于中剂量组和低剂量组。3组给药组均能明显降低患者血清中肾素、血管紧张素Ⅱ、醛固酮水平,差异具有统计学意义(P<0.01或0.05)。结论:米力农能较好的缓解肺动脉高压,提高患者的肺功能。本研究为米力农的相关机制研究和临床实践提供了重要参考。
Objective: To study the different doses effect of milrinone to the treatment of patients with pulmonary artery hypertension. Based on this,the mechanism of milrinone to pulmonary artery hypertension have been discussed. Methods: Mean arterial pressure,pulmonary artery pressure,pulmonary ascular resistance,serum renin,angiotensin and aldosterone levels and 6 minutes walk steps were detected after and before the treatment. Results:Compared with control group,pulmonary arterial pressure,mean arterial pressure,pulmonary vascular resistance in the patients of the three groups decreased significantly( P < 0. 01 or 0. 05),and significantly improve steps of 6-minutes walk( P < 0. 01 or 0. 01). The results in the high dose group was better than those middle dose group and low dose group. In terms of reducing serum renin,angiotensin Ⅱ,aldosterone levels with statistically significant difference( P < 0. 01 or 0. 01). Conclusion: Milrinone can alleviate pulmonary hypertension,improve the patients' lung function. This study for milrinone can make a example for mechanism research and clinical practice.
Objective: To study the different doses effect of milrinone to the treatment of patients with pulmonary artery hypertension. Based on this,the mechanism of milrinone to pulmonary artery hypertension have been discussed. Methods: Mean arterial pressure,pulmonary artery pressure,pulmonary ascular resistance,serum renin,angiotensin and aldosterone levels and 6 minutes walk steps were detected after and before the treatment. Results:Compared with control group,pulmonary arterial pressure,mean arterial pressure,pulmonary vascular resistance in the patients of the three groups decreased significantly( P < 0. 01 or 0. 05),and significantly improve steps of 6-minutes walk( P < 0. 01 or 0. 01). The results in the high dose group was better than those middle dose group and low dose group. In terms of reducing serum renin,angiotensin Ⅱ,aldosterone levels with statistically significant difference( P < 0. 01 or 0. 01). Conclusion: Milrinone can alleviate pulmonary hypertension,improve the patients' lung function. This study for milrinone can make a example for mechanism research and clinical practice.
引文
[1]CHEMLA D,HUMBERT M,SITBON O,et al.Systolic and mean pulmonary artery pressures:are they interchangeable in patients with pulmonary hypertension?[J].Chest,2015,147(4):943-950.
[2]刘璐.雾化吸入磷酸二酯酶3抑制剂—米力农对合并肺动脉高压的慢性阻塞性疾病患者的临床观察[D].昆明医科大学,2014.
[3]HARALDSSON S A,KIELER-JENSEN N,RICKSTEN S E.The additive pulmonary vasodilatory effects of inhaled prostacyclin and inhaled milrinone in postcardiac surgical patients with pulmonary hypertension[J].Anesth Analg,2001,93(6):1439.
[4]GESSLER P,KACHEL W.Additive effects of inhaled nitric oxide and intravenous milrinone in experimental pulmonary hypertension[J].Crit Care Med,2000,28(3):795-799.
[5]赵向东,陆龙,崔振田.前列腺素E与米力农对室间隔缺损合并肺动脉高压患儿术后疗效比较[J].疑难病杂志.2010(06):406-407.
[6]CAREV M,BULAT C,KARANOVIC N,et al.Combined usage of inhaled and intravenous milrinone in pulmonary hypertension after heart valve surgery[J].Coll Antropol,2010,34(3):1113-1117.
[7]AKTAST,AKTASF,ZO,et al.Does crimean-congo hemorrhagic fever cause a vasculitic reaction with pulmonary artery enlargement and acute pulmonary hypertension?[J].Lung,2016,194(5):1-6.
[8]LAKSHMINRUSIMHA S,KESZLER M.Persistent pulmonary hypertension of the newborn[J].NeoReviews,2015,16(12):e680.
[9]GOSSL M,KANE G C,MAUERMANN W,et al.Pulmonary hypertension in patients undergoing transcatheter aortic valve replacement:discussion of the current evidence[J].Circ Cardiovasc Interv,2015,8(6):e2253.
[10]HAGA S,TSUCHIYA H,HIRAI T,et al.A novel ACE2 activator reduces monocrotaline-induced pulmonary hypertension by suppressing the JAK/STAT and TGF-βcascades with restored caveolin-1 expression[J].Exp Lung Res,2015,41(1):21-31.
[11]BEN-SHOSHAN J,ENTIN-MEER M,GUZNER-GUR H,et al.The cardiorenal syndrome:a mutual approach to concomitant cardiac and renal failure[J].Isr Med Assoc J,2012,14(9):570-576.
[12]NG T M,ACKERBAUER K A,HYDERI A F,et al.Comparative effects of nesiritide and nitroglycerin on renal function,and incidence of renal injury by traditional and RIFLE criteria in acute heart failure[J].J Cardiovasc Pharmacol Ther,2012,17(1):79-85.
[2]刘璐.雾化吸入磷酸二酯酶3抑制剂—米力农对合并肺动脉高压的慢性阻塞性疾病患者的临床观察[D].昆明医科大学,2014.
[3]HARALDSSON S A,KIELER-JENSEN N,RICKSTEN S E.The additive pulmonary vasodilatory effects of inhaled prostacyclin and inhaled milrinone in postcardiac surgical patients with pulmonary hypertension[J].Anesth Analg,2001,93(6):1439.
[4]GESSLER P,KACHEL W.Additive effects of inhaled nitric oxide and intravenous milrinone in experimental pulmonary hypertension[J].Crit Care Med,2000,28(3):795-799.
[5]赵向东,陆龙,崔振田.前列腺素E与米力农对室间隔缺损合并肺动脉高压患儿术后疗效比较[J].疑难病杂志.2010(06):406-407.
[6]CAREV M,BULAT C,KARANOVIC N,et al.Combined usage of inhaled and intravenous milrinone in pulmonary hypertension after heart valve surgery[J].Coll Antropol,2010,34(3):1113-1117.
[7]AKTAST,AKTASF,ZO,et al.Does crimean-congo hemorrhagic fever cause a vasculitic reaction with pulmonary artery enlargement and acute pulmonary hypertension?[J].Lung,2016,194(5):1-6.
[8]LAKSHMINRUSIMHA S,KESZLER M.Persistent pulmonary hypertension of the newborn[J].NeoReviews,2015,16(12):e680.
[9]GOSSL M,KANE G C,MAUERMANN W,et al.Pulmonary hypertension in patients undergoing transcatheter aortic valve replacement:discussion of the current evidence[J].Circ Cardiovasc Interv,2015,8(6):e2253.
[10]HAGA S,TSUCHIYA H,HIRAI T,et al.A novel ACE2 activator reduces monocrotaline-induced pulmonary hypertension by suppressing the JAK/STAT and TGF-βcascades with restored caveolin-1 expression[J].Exp Lung Res,2015,41(1):21-31.
[11]BEN-SHOSHAN J,ENTIN-MEER M,GUZNER-GUR H,et al.The cardiorenal syndrome:a mutual approach to concomitant cardiac and renal failure[J].Isr Med Assoc J,2012,14(9):570-576.
[12]NG T M,ACKERBAUER K A,HYDERI A F,et al.Comparative effects of nesiritide and nitroglycerin on renal function,and incidence of renal injury by traditional and RIFLE criteria in acute heart failure[J].J Cardiovasc Pharmacol Ther,2012,17(1):79-85.