西地那非长期治疗不能手术的慢性血栓栓塞性肺动脉高压

     研究证明，仅仅只有少数慢性血栓栓塞性肺动脉高压患者适合做肺动脉血栓内膜剥脱术(pulmonary thrombendarterectomy )治疗。作者报道12例病情进展的慢性血栓栓塞性肺动脉高压患者，即使长期使用足量的抗凝药物和最好的支持护理疗法，但仍有严重的肺动脉高压。经过西地那非治疗6个月后，肺血液动力学和运动能力明显改善。治疗方法：西地那非50mg开始，4-5天后逐渐加量。

Sildenafil for Long-Term Treatment of Nonoperable Chronic Thromboembolic Pulmonary Hypertension

Hossein A. Ghofrani, Ralph T. Schermuly, Frank Rose, Ralph Wiedemann, Markus G. Kohstall, André Kreckel, Horst Olschewski, Norbert Weissmann, Beate Enke, Stefanie Ghofrani, Werner Seeger and Friedrich Grimminger.American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1139-1141, (2003)

ABSTRACT Only a small percentage of patients with chronic thromboembolic pulmonary hypertension are eligible for pulmonary thrombendarterectomy. We investigated the effects of oral sildenafil on hemodynamics and exercise capacity in 12 nonoperable chronic thromboembolic pulmonary hypertension patients. All patients were in disease progression despite sufficient long-term anticoagulation and the best supportive care and suffered from severe pulmonary hypertension (pulmonary vascular resistance index 1,935 ± 228 dyn · s · cm-5 · m2, cardiac index 2.0 l · min-1 · m-2, 6-minute walking distance 312 ± 30 m). After approximately 6 months of sildenafil treatment, pulmonary hemodynamics and exercise capacity improved significantly (pulmonary vascular resistance index 1,361 ± 177 L · min-1 · m2 , p = 0.004, cardiac index 2.4 ± 0.2 L · min-1 · m-2, p = 0.009, 6-minute walking distance 366 ± 28 m, p = 0.02). Therefore, oral sildenafil may offer a new option for medical treatment of this devastating disease.