Effect and Usefulness of Adenosine on Experimental Pulmonary Hypertension

抄録

Background: The mechanism by which onset of postoperative pulmonary hypertensive crisis occurs in congenital heart disease patients accompanying pulmonary hypertension is still unclear, and in many cases may greatly complicate treatment. The purpose of this study was to examine on the pharmacological effects of adenosine on pulmonary hypertension. Methods: Twelve pigs with an experimental pulmonary hypertension (age, about 2 months. mean weight, 10.9kg) were studied under general anesthesia. An experimental pulmonary hypertension was induced by giving hypoxic inhalation with FiO_2=0.1. Data was collected for mean systemic artery pressure (MAP), mean pulmonary artery pressure (MPAP), central venous pressure (CVP), left atrial pressure (LAP), and cardiac output. And cardiac index, MAP, MPAP, CVP, LAP, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), PVR/SVR ratio, and MPAP/MAP ratio were determined before, during, and after central venous infusion of adenosine (20 to 80μg・kg^<-1>・min^<-1>) for 30 minutes. Statistical analysis was performed using ANOVA and Tukey's post hoc analysis, and statistical significance was defined as a P-value of less than 0.05. Results: Effective adenosine concentration was 40μg・kg^<-1>・min^<-1> (11 out of 12 cases). Concerning the effects of adenosine on experimental acute PH in pigs, MPAP was significantly decreased from 26.9mmHg to 17.3mmHg (p<0.01), and PVR was significantly decreased from 4.2 Wood units (W.u.) to 1.9±1.1 W.u. (p<0.01). No change in systemic circulation during adenosine infusion occurred. Conclusion: This study showed that adenosine selectively decreased PAP and PVR without decreasing systemic blood pressure and SVR. The results of this study suggest that adenosine may be available clinically for the treatment of perioperative and postoperative pulmonary hypertension for infants and young children.