Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery u...Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery under different administration strategies.Methods:We retrospectively included pediatric patients admitted to Fuwai Hospital from 2019 to 2022 who underwent the Glenn procedure and had intraoperative measurements of mean pulmonary artery pressure(mPAP)>15 mmHg postoperatively.Patients with non-anatomical single ventricle physiology undergoing the Glenn procedure and those requiring postoperative extracorporeal membrane oxygenation were excluded.Due to the standardized use of treprostinil in our center starting in 2021,patients from 2019–2020 were included in Group 1,and patients from 2021–2022 were included in Group 2.The changes in hemodynamic data before and after medication for both groups of patients,as well as the differences in postoperative recovery,were compared.Results:Twenty-eight patients were eventually enrolled in the study.Group 1 consisted of 14 cases,with a maintenance dose of 11±2 ng/(kg·min)1 to 2 days postoperatively.Group 2 also consisted of 14 cases,with a maintenance dose of 26±7 ng/(kg·min)1 day postoperatively.After a 24-h observation period,the mPAP decreased from 17±3 to 13±3 mmHg(p<0.001)in the first group and decreased from 18±3 to 13±3 mmHg(p<0.001)in the second group.The vasoactive-inotropic score in the first group decreased from 9(6,17)to 6(4,9)(p=0.001)and decreased from 12(6,23)to 10(3,15)(p=0.002)in the second group.Group 2 patients had a shorter postoperative hospital stay than Group 1,with durations of 18(11,22)days and 29(19,47)days,respectively(p=0.021).No severe adverse reactions occurred in all patients.Conclusion:Intravenous infusion of treprostinil in high-risk patients after the Glenn procedure can decrease pulmonary artery pressure,reduce vasoactive-inotropic score,and demonstrate satisfactory drug tolerance without severe adverse reactions.Standardized use of treprostinil facilitates postoperative recovery and shortens postoperative length of stay.展开更多
Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections...Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver transplantation.In addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and systems.Thus,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality rates.Treprostinil is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging results.It has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/min.Treprostinil improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of mitochondria.Treprostinil exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion injury.Additionally,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.展开更多
目的:快速评价曲前列尼尔治疗肺动脉高压(PAH)的有效性、安全性和经济性,为临床药物选择和决策提供循证参考。方法:系统检索PubMed、Embase、Web of Science、Cochrane图书馆、Epistemonikos、英国约克大学卫生技术评估(HTA)数据库、中...目的:快速评价曲前列尼尔治疗肺动脉高压(PAH)的有效性、安全性和经济性,为临床药物选择和决策提供循证参考。方法:系统检索PubMed、Embase、Web of Science、Cochrane图书馆、Epistemonikos、英国约克大学卫生技术评估(HTA)数据库、中国知网和万方数据等中英文数据库,纳入曲前列尼尔对比安慰剂或其他药物治疗PAH的HTA报告、系统评价/Meta分析和药物经济研究,检索时限均为建库起至2020年5月1日。分别采用HTA checklist、AMSTA、卫生经济学评价报告标准共识量表评价纳入HTA、系统评价/Meta分析、药物经济学研究的文献质量,并进行描述性汇总分析。结果:共纳入文献18篇,其中HTA报告1篇、系统评价/Meta分析12篇、药物经济学研究5篇。有效性分析结果显示,相比于安慰剂,曲前列尼尔可显著延长PAH患者的6分钟步行距离(6-MWD)、降低其Borg呼吸困难评分(P<0.05),而对死亡率、临床恶化率、世界卫生组织(WHO)功能分级、入院治疗率和平均肺动脉压、肺血管阻力、心脏指数和平均右动脉压等指标无显著影响(P>0.05);此外,与安慰剂联合内皮素受体拮抗剂和/或磷酸二酯酶抑制剂比较,曲前列尼尔口服给药联合内皮素受体拮抗剂和/或磷酸二酯酶抑制剂能显著延长患者的6-MWD;与利奥西呱比较,曲前列尼尔可显著降低患者Borg呼吸困难评分。安全性分析结果表明,虽然接受曲前列尼尔治疗的患者因不能耐受不良反应(ADR)而停药的发生率有所增加(P<0.05),但严重不良事件(SAEs)的发生率与安慰剂和其他治疗药物比较均无显著性差异(P>0.05),且经吸入或静脉注射途径给药时患者的耐受性更好。经济性分析结果表明,虽然不同国家不同支付方的意愿支付阈值不同,但曲前列尼尔的增量成本-效果比高于意愿支付阈值。结论:曲前列尼尔治疗PAH具有良好的有效性,患者虽可能因不能耐受ADR而停药,但不会增加SAEs的发生风险;该药虽然价格偏高,但仍是临床治疗进展期或预后不良PAH患者的重要备选方案。展开更多
目的评价曲前列尼尔治疗重症特发性肺动脉高压(IPAH)患儿的短期临床效果和安全性。方法收集2018年5月至2020年12月就诊于首都医科大学附属北京安贞医院小儿心脏中心年龄<18周岁的16例短期持续皮下泵入曲前列尼尔治疗的重症IPAH患儿...目的评价曲前列尼尔治疗重症特发性肺动脉高压(IPAH)患儿的短期临床效果和安全性。方法收集2018年5月至2020年12月就诊于首都医科大学附属北京安贞医院小儿心脏中心年龄<18周岁的16例短期持续皮下泵入曲前列尼尔治疗的重症IPAH患儿的临床资料进行回顾性分析。收集其病史、临床症状、治疗策略及随访数据,比较随访及基线时的相关临床指标,观察不良反应发生情况。结果入组患儿年龄为(9±5)岁,纽约心脏病协会(NYHA)心功能分级Ⅲ级11例、Ⅳ级5例,在为期(68±34)d的随访中,患儿心功能明显改善,Ⅱ级15例、Ⅲ级1例。患儿随访时B型脑钠肽、三尖瓣反流最大峰值速度、三尖瓣反流压差、主肺动脉内径与主动脉根部内径比值、右心室前后径与左心室舒张末期内径比值均较基线时明显下降[(135±98)ng/L比(380±353)ng/L、(426±58)cm/s比(467±49)cm/s、(73±19)mm Hg(1 mm Hg=0.133 k Pa)比(88±19)mm Hg、(1.32±0.22)比(1.62±0.47)、(0.6±0.3)比(0.9±0.6)],差异均有统计学意义(均P<0.05)。起始用药5 d内,2例患儿诉输注部位疼痛,3例诉间断头痛,2例表现为面部潮红,调整用药剂量及对症支持治疗后均能耐受,无患儿因无法耐受而终止治疗。结论曲前列尼尔治疗重症IPAH患儿安全有效,且耐受性良好。展开更多
基金supported by the Clinical Research Foundation of the National Health Commission of the People’s Republic of China(grant numbers:2022-GSP-GG-32,2022-GSP-QN-13 and 2023-GSP-QN-5).
文摘Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery under different administration strategies.Methods:We retrospectively included pediatric patients admitted to Fuwai Hospital from 2019 to 2022 who underwent the Glenn procedure and had intraoperative measurements of mean pulmonary artery pressure(mPAP)>15 mmHg postoperatively.Patients with non-anatomical single ventricle physiology undergoing the Glenn procedure and those requiring postoperative extracorporeal membrane oxygenation were excluded.Due to the standardized use of treprostinil in our center starting in 2021,patients from 2019–2020 were included in Group 1,and patients from 2021–2022 were included in Group 2.The changes in hemodynamic data before and after medication for both groups of patients,as well as the differences in postoperative recovery,were compared.Results:Twenty-eight patients were eventually enrolled in the study.Group 1 consisted of 14 cases,with a maintenance dose of 11±2 ng/(kg·min)1 to 2 days postoperatively.Group 2 also consisted of 14 cases,with a maintenance dose of 26±7 ng/(kg·min)1 day postoperatively.After a 24-h observation period,the mPAP decreased from 17±3 to 13±3 mmHg(p<0.001)in the first group and decreased from 18±3 to 13±3 mmHg(p<0.001)in the second group.The vasoactive-inotropic score in the first group decreased from 9(6,17)to 6(4,9)(p=0.001)and decreased from 12(6,23)to 10(3,15)(p=0.002)in the second group.Group 2 patients had a shorter postoperative hospital stay than Group 1,with durations of 18(11,22)days and 29(19,47)days,respectively(p=0.021).No severe adverse reactions occurred in all patients.Conclusion:Intravenous infusion of treprostinil in high-risk patients after the Glenn procedure can decrease pulmonary artery pressure,reduce vasoactive-inotropic score,and demonstrate satisfactory drug tolerance without severe adverse reactions.Standardized use of treprostinil facilitates postoperative recovery and shortens postoperative length of stay.
文摘Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver transplantation.In addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and systems.Thus,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality rates.Treprostinil is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging results.It has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/min.Treprostinil improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of mitochondria.Treprostinil exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion injury.Additionally,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.
文摘目的:快速评价曲前列尼尔治疗肺动脉高压(PAH)的有效性、安全性和经济性,为临床药物选择和决策提供循证参考。方法:系统检索PubMed、Embase、Web of Science、Cochrane图书馆、Epistemonikos、英国约克大学卫生技术评估(HTA)数据库、中国知网和万方数据等中英文数据库,纳入曲前列尼尔对比安慰剂或其他药物治疗PAH的HTA报告、系统评价/Meta分析和药物经济研究,检索时限均为建库起至2020年5月1日。分别采用HTA checklist、AMSTA、卫生经济学评价报告标准共识量表评价纳入HTA、系统评价/Meta分析、药物经济学研究的文献质量,并进行描述性汇总分析。结果:共纳入文献18篇,其中HTA报告1篇、系统评价/Meta分析12篇、药物经济学研究5篇。有效性分析结果显示,相比于安慰剂,曲前列尼尔可显著延长PAH患者的6分钟步行距离(6-MWD)、降低其Borg呼吸困难评分(P<0.05),而对死亡率、临床恶化率、世界卫生组织(WHO)功能分级、入院治疗率和平均肺动脉压、肺血管阻力、心脏指数和平均右动脉压等指标无显著影响(P>0.05);此外,与安慰剂联合内皮素受体拮抗剂和/或磷酸二酯酶抑制剂比较,曲前列尼尔口服给药联合内皮素受体拮抗剂和/或磷酸二酯酶抑制剂能显著延长患者的6-MWD;与利奥西呱比较,曲前列尼尔可显著降低患者Borg呼吸困难评分。安全性分析结果表明,虽然接受曲前列尼尔治疗的患者因不能耐受不良反应(ADR)而停药的发生率有所增加(P<0.05),但严重不良事件(SAEs)的发生率与安慰剂和其他治疗药物比较均无显著性差异(P>0.05),且经吸入或静脉注射途径给药时患者的耐受性更好。经济性分析结果表明,虽然不同国家不同支付方的意愿支付阈值不同,但曲前列尼尔的增量成本-效果比高于意愿支付阈值。结论:曲前列尼尔治疗PAH具有良好的有效性,患者虽可能因不能耐受ADR而停药,但不会增加SAEs的发生风险;该药虽然价格偏高,但仍是临床治疗进展期或预后不良PAH患者的重要备选方案。
文摘目的评价曲前列尼尔治疗重症特发性肺动脉高压(IPAH)患儿的短期临床效果和安全性。方法收集2018年5月至2020年12月就诊于首都医科大学附属北京安贞医院小儿心脏中心年龄<18周岁的16例短期持续皮下泵入曲前列尼尔治疗的重症IPAH患儿的临床资料进行回顾性分析。收集其病史、临床症状、治疗策略及随访数据,比较随访及基线时的相关临床指标,观察不良反应发生情况。结果入组患儿年龄为(9±5)岁,纽约心脏病协会(NYHA)心功能分级Ⅲ级11例、Ⅳ级5例,在为期(68±34)d的随访中,患儿心功能明显改善,Ⅱ级15例、Ⅲ级1例。患儿随访时B型脑钠肽、三尖瓣反流最大峰值速度、三尖瓣反流压差、主肺动脉内径与主动脉根部内径比值、右心室前后径与左心室舒张末期内径比值均较基线时明显下降[(135±98)ng/L比(380±353)ng/L、(426±58)cm/s比(467±49)cm/s、(73±19)mm Hg(1 mm Hg=0.133 k Pa)比(88±19)mm Hg、(1.32±0.22)比(1.62±0.47)、(0.6±0.3)比(0.9±0.6)],差异均有统计学意义(均P<0.05)。起始用药5 d内,2例患儿诉输注部位疼痛,3例诉间断头痛,2例表现为面部潮红,调整用药剂量及对症支持治疗后均能耐受,无患儿因无法耐受而终止治疗。结论曲前列尼尔治疗重症IPAH患儿安全有效,且耐受性良好。
