在儿科心脏重症监护病房重度肺高血压的持续前列腺启动
Richard U Garcia1, Asaad Beshish2, Arene Butto2
1Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Rd, Suite 400, Atlanta, GA, 30341, USA. rugarci@emory.edu.
Pediatric cardiology
|September 12, 2023
概括
在儿科心脏重症监护病房使用前列腺素 (PGI2) 是有限的. 低血压是最常见的副作用,导致三分之一接受PGI2治疗的患者停止治疗.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 重症儿童的肺高血压 (PH) 存在管理方面的挑战.
- 关于小儿心脏重症监护室 (CICU) 的前列腺类药物 (PGI2) 疗效和安全性的数据有限.
研究的目的:
- 评估持续性前列腺类药物 (PGI2) 治疗在患有肺高血压 (PH) 的重症儿科患者中的使用,耐受性和结果.
主要方法:
- 从2015年1月到2022年4月,对24名PH儿科患者进行了回顾性,单中心的研究,这些患者从2015年1月到2022年4月持续接受PGI2.
- 数据包括人口统计,PH病因,PGI2类型/剂量,血管活性/呼吸支持和生存率.
- 分析了血液动力学数据和不良事件.
主要成果:
- 对24名患者 (平均年龄为3.1岁) 进行了PGI2治疗 (epoprostenol,treprostinil).
- 在开始时,87.5%的人接受了血管活性输液,79.2%的人接受机械通风,25%的人接受了ECMO.
- 住院死亡率为37.5%;机械通风和ECMO与较高的死亡风险有关.
结论:
- 大约50%的患者耐受了前列腺类药物 (PGI2) 治疗,而低血压是三分之一的患者停止治疗的主要原因.
- 需要进行进一步的研究,以优化患者选择,PGI2类型和CICU环境中的剂量.
相关概念视频
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
210
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
210
Pulmonary Hypertension: Classification and Pathogenesis
216
Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
There are various classifications for PH, each relating to different underlying causes and also...
216
Pulmonary Embolism I: Introduction
7
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
7
COPD: Management Using Bronchodilators and Corticosteroids
241
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
241
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
197
Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
197
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
10
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10


