Sildenafil Decreases Pulmonary Hypertension in a Mechanically Ventilated Patient with Idiopathic Pulmonary Fibrosis-A Case Report

口服威而剛有效降低一位原發性肺纖維化併動脈高壓既使用呼吸器病人之肺動脈壓－病例報告

梁啟彥(Chi-Yen Liang) ； 陳昌文(Chang-Wen Chen) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 21卷5期 (2006/10) Pp. 468-472

https://doi.org/10.29806/TM.200610.0011

摘要

肺動脈高壓是一個預後不佳的疾病，若已合併有右心衰竭的情況，則預估存活期不超過一年。對於這類的病患，擴張肺動脈血管，抑制血管內皮增生以及預防血栓形成是主要的治療目標。吸入NO藉由增加細胞內的cGMP濃度，可選擇性使肺動脈血管的平滑肌放鬆，達到降低肺動脈阻力，降低肺動脈壓，提高運動耐受性(exercise capacity)，甚至在某些病人可使血氣濃度上升的效果。然而NO氣體的攜帶與使用不易限制了其在臨床上的應用。Sildenafil（威而剛）可抑制體內分解NO的酶(phosphodiesterase，PDE)，且對此酶在肺內含量最高的PDE-5有選擇性的抑制作用，因此可在較不影響全身血壓的情況下達到降低肺動脈壓的效果。文獻已證實sildenafil對於原發性及次發性肺動脈高壓皆有療效。我們將其使用在一位因肺纖維化引起肺動脈高壓，敗血症併呼吸衰竭的病人，希望病人的血氧濃度能有所改善。病人的肺動脈壓與肺血管阻力在使用sildenafil後明顯降低，但血氣濃度並無明顯的改善，而病人終究病逝於呼吸衰竭。

關鍵字

威而剛Sildenafil ； 肺動脈高壓 ； 原發性肺纖維化

並列摘要

Sildenafil (Viagra), a phosphodiesterase-5 (PDE-5) inhibitor, has been shown to reduce pulmonary arterial pressure in patients with either primary or secondary pulmonary hypertension. However, to our knowledge, the use of sildenafil in mechanically ventilated patients with pulmonary hypertension has never been reported. Herein, we described the case of a patient with idiopathic pulmonary fibrosis and secondary pulmonary hypertension, who was intubated due to acute respiratory failure. Oral sildenafil was given for persistent hypoxemia and pulmonary hypertension. The patient's pulmonary artery pressure decreased after sildenafil (from 60/27mmHg to 36/19mmHg, half an hour post-sildenafil intake), but the aim of improving oxygenation was not reached during treatment. He ultimately died of refractory hypoxemia.

並列關鍵字

sildenafil ； pulmonary hypertension ； idiopathic pulmonary fibrosis