与慢性肺部疾病相关的肺高血压的管理
Isabel Blanco1,2,3, Fernanda Hernández-González1,2,3, Agustín García1,2,3
1Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain.
肺高血压 (PH) 复杂化慢性肺部疾病,如COPD和ILD,增加死亡率. 诊断需要仔细评估,治疗重点是氧气治疗和肺部康复,针对性治疗只适用于严重病例.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 肺高血压 (PH) 经常使慢性肺病复杂化,特别是慢性阻塞性肺病 (COPD) 和间歇性肺病 (ILD),特别是在晚期.
- 这种并发症与增加的死亡率和较差的临床预后有关.
- 在患有潜在肺部疾病的患者中诊断PH是一个重大的临床挑战,因为症状重叠和潜在的辅酶体异常.
研究的目的:
- 概述与呼吸道疾病相关的肺高血压的诊断挑战和治疗策略.
- 为患者评估提供指导,包括心声回声和右心导管.
- 根据PH的严重程度和患者的病情,确定适当的治疗方法.
主要方法:
- 对慢性肺病患者PH的临床表现和诊断工作的审查.
- 讨论血液动力学评估的指示,包括右心脏导管.
- 分析当前的治疗指南,包括氧疗法,肺部康复和药物治疗.
主要成果:
- 建议对慢性肺病患者进行心声扫描,这些患者的症状超过预期.
- 对手术候选人,严重PH评估和治疗决定性的血液动力学评估来说,右心导管非常重要.
- 传统的血管扩张剂和PAH批准的药物不推用于轻度至中度PH,原因是潜在的危害和缺乏经过证明的疗效.
结论:
- 长期的氧气治疗和肺部康复是PH和慢性肺部疾病的低血症患者的首要治疗方法.
- 肺移植在某些特定情况下提供了治愈的选择.
- 严重的PH患者需要转诊到专门的中心,可以考虑针对性PAH治疗,并进行仔细监测;吸入的特雷普罗斯尼尔在ILD相关的PH中显示出希望.
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