Study Of Effect Of Prostaglandin E₁ On Peri-operative Pulmonary Hypertension

Objective: Hypertension is one of the common and serious complications of the congenital heart disease(CHD) and the rheumatic heart disease(RHD). With the basic treatment of prostaglandin E} on pulmonary hypertension, this research is mainly to explore the time-effect relationship, the dose-effect relationship of PGE,, the similarities and differences of reaction of PGE, on patients with congenital heart disease and rheumatic heart disease as well as its special effect on the hypertension crisis.Methods: First, twenty-nine patients associated with pulmonary hypertension were divided into two groups: (1) The congenital heart disease patients (n=18) (2) The rheumatic heart disease patients (n=ll). Swan-Ganz float catheter was put into pulmonary artery through right jugular just after anaesthesia, following indexes were examined both before and after using PGE, (20ng/kg/min) so that we studied the effect on pulmonary hypertension: mean arterial pressure (mAP), mean pulmonary arterial pressure (mPAP), mean pulmonary capillary wedge pressure (mPCWP), cardiac index (CI), heart rate (HR), arterial oxygen pressure(PO2), arterial carbon dioxide pressure(PCO2), arterial oxygen saturation(SO2)and mean ventilation pressure(mVP). We examined these indexes after using PGE, at 0, 5, 10, 20, 30 minutesrespectively so that we studied its time-effect relationship. Those indexes were also examined after using PGE, at the doses: 5, 10, 20, 40, 80ng/kg/min respectively, so that we studied its dose-effect relationship. After using PGE, 20ng/kg/min at 10s 20> 30 minutes respectively, mPAP -. mPCWP >. CI were compared so that we studied the similarities and differences of reaction of PGE, on different group patients. On the other hand, eleven CPB patients associated with pulmonary hypertension crisis were used PGE, (63.7i23ng/kg/min) through right atria and PE (0.47 + 0.09ug/kg/ min) through left atria, and those indexes were examined so that we studied its special effect on pulmonary hypertension crisis. Variables were expressed as meani standard deviation (x i s) and self-antitheses / tests were done to evaluate differences,^ value of less 0.05 was required for significance.Results: (1) After using PGE^Ong/kg/min, mean pulmonary arterial pressure (mPAP) and mean pulmonary capillary wedge pressure (mPCWP) decreased significantly (P<0.05) (change rate: CHD: -32.37%, -15.27%; RHD: -20.08%, -15.2%); cardiac index(CI) increased significandy(P<0.05) (change rate: CHD:+13.37%.RHD: +9.79%); changes of other indexes were not significant(P>0.05).(2) After using PGE1(20ng/kg/min) 5 minutes, there was no significant change (P>0.05); after using PGE, (20ng/kg/min) 10 minutes, die effect was sigmficant(P<0.05); after using PGE1(20ng/kg/min) 20 and 30 minutes, the effect was no more significant(P>0.05).(3) There was no significance after using PGE, at the dose of 5 or 10ng/kg/min(P>0.05). The changes of mPAl\ mPCWP and CI were significant after using PGE, at the dose of 20, 40 or 80ng/kg/min (1X0.05). (4) After using PGE,(20ng/kg/min) on patients with CHD and RHD respectively, the indexes' differences were significant (P<0.05). (5) After using PGE, and PE 10 minutes, mPAP % PVRI N CVP in all patients decreased significantly (P<0.01); mAP and SVRI increased significantly (P<0.01)Conclusions: The effect of PGE, on pulmonary hypertension caused by congenital or rheumatic heart disease is significant. PGE^ can decrease mean pulmonary arterial pressure (mPAP) and mean pulmonary capillary wedge pressure (mPCWP) remarkably, and it can also increase cardiac index (CI) significandy. The optimal dose of PGE, is 20~40ng/kg/min. The effect is remarkable after using PGE1 10 minutes and its effect is stable after 20-30minutes. The effect of PGE1 on pulmonary hypertension caused by congenital heart disease is more remarkably than that caused by rheumatic heart disease. The effect of PGE, on pulmonary hypertension crisis is significant.