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Title: [Acute effects of intravenous fasudil with different dosage on patients with congenital heart defects and severe pulmonary arterial hypertension].
Author: Ruan HY, Zhang YG, Liu R.
Journal: Zhonghua Yi Xue Za Zhi; 2018 Mar 06; 98(9):678-681. PubMed ID: 29534403.
Abstract:
Objective: To compare the acute hemodynamic effects of intravenous fasudil with different dosage on patients with congenital heart defects (CHD) and severe pulmonary arterial hypertension (PAH). Methods: Sixty patients (37±17 years old) with CHD and PAH were consecutively enrolled. All patients underwent heart catheterization. The patients were randomly divided into two groups: the regular dosage group and the large dosage group. At initiation and 30 min after intravenous fasudil(30 mg and 60 mg respectively), the following hemodynamic parameters were measured and calculated: right atrial pressure(RAP), pulmonary arterypressure(PAP) , systemic artery pressure (SAP), pulmonary capillary wedge pressure(PCWP) , pulmonary vascular resistance(PVR) and systemic vascular resistance( SVR), cardiac index (CI) and artery oxygen saturation (SaO(2)). Results: Compared with pre-medication, both mPAP and PVR tended to reduce significantly in the regular dosage group and the large dosage group: mPAP from (63.7±8.6)to (58.3±8.5)mmHg(P<0.01) and from (62.9±8.8) to(55.1±7.8)mmHg (P<0.01), respectively; PVR from(9.9±4.3)to (7.7±3.9) Wood(P<0. 01) and from (9.5±4.9)to(6.1±4.8)Wood(P<0.01); CI tended to increase significantly in the two groups: from (2.9±0.9) to (3.1±1.1) L·min(-1)·m(-2)( P<0.05) and from(3.0±0.8) to (3.5±1.6) L·min(-1)·m(-2)( P<0.05), respectively . Compared with the regular dosage group, both mPAP and PVR tended to reduce significantly in the large dosage group: mPAP (8.2±1.8) vs (4.2±1. 0)mmHg (P<0.05); PVR(3.7±1.1) vs (2.1±0.8 ) Wood (P<0.05) .Meanwhile , there was no significant difference in CI, SAP, SVR and SaO(2) between the two groups. Conclusion: Fasudil could improve the acute hemodynamic effects of patients with CHD and severe PAH, especially in the large dosage group. 目的：比较静脉应用不同剂量Rho激酶抑制剂法舒地尔对成人先天性心脏病伴重度肺动脉高压患者急性血流动力学的影响。 方法：选取2013年6月至2016年6月在东南大学医学院附属徐州医院住院合并重度肺动脉高压的成人先天性心脏病患者60例[年龄(37±17)岁]为研究对象，按照随机数字表，将所有合格病例随机分为两组：常规剂量组(n＝30)，大剂量组(n＝30)。所有病人均通过右心导管检查行血流动力学测定，包括外周动脉压(mSAP)、右心房平均压(mRAP)、右心室平均压(mRVP)、肺动脉收缩压(sPAP)、肺动脉舒张压(dPAP)、肺动脉平均压(mPAP)、肺动脉楔压(PCWP)，并通过公式推算全肺血管阻力(PVR)、外周动脉血管阻力(SVR)、心脏指数(CI)等。常规剂量组以Rho激酶抑制剂法舒地尔30 mg＋50 ml生理盐水静脉30 min泵入，大剂量组法舒地尔60 mg＋50 ml生理盐水静脉30 min泵入，静脉泵入药物结束后再次行以上相关血流动力学参数检查。 结果： (1)与用药前比较，常规剂量组的mPAP由(63.7±8.6)mmHg降至(58.3±8.5)mmHg(P<0.01)，PVR由(9.9±4.3)Wood降至(7.7±3.9)Wood(P<0.01)，CI由(2.9±0.9)L·min(－1)·m(－2)升至(3.1±1.1)L·min(－1)·m(－2)(P<0.05)；大剂量组的mPAP由(62.9±8.8)mmHg降至(55.1±7.8)mmHg(P<0.01)，PVR由(9.5±4.9)Wood降至(6.1±4.8)Wood(P<0.01)，CI由(3.0±0.8) L·min(－1)·m(－2)升至(3.5±1.6)L·min(－1)·m(－2)(P<0.05)。(2)与常规剂量组比较，大剂量组用药前后的mPAP和PVR下降幅度更为明显，mPAP为[(8.2±1.8)mmHg比(4.2±1. 0)mmHg P<0.05]、PVR为[(3.7±1.1)Wood比(2.1±0.8)Wood P<0.05]。两组间CI、SVR、mSAP、SaO(2)变化差异无统计学意义(P>0.05)。 结论： Rho激酶抑制剂法舒地尔快速短期静脉应用可改善先天性心脏病伴肺动脉高压患者的急性血流动力学效应，大剂量组可以达到更好的治疗效果。.

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