摘要
目的探讨先天性心脏病合并肺动脉高压患者围术期管控方法,总结先天性心脏病合并肺动脉高压围术期管理经验。方法回顾性分析武警北京市总队第二医院2007年3月至2014年6月收治的143例先天性心脏病合并肺动脉高压的患者,全部患者术前均行超声心动图(UCG)检查,87例行右心导管检查(RHC),对UCG和RHC检查结果、围术期是否服用降低肺动脉压药物等方面进行分析研究。结果本组143例中多数经过介入导管科会诊,认为肺动脉高压不适合介入封堵治疗,其中51例房间隔缺损、室间隔缺损、动脉导管未闭,在介入封堵治疗失败后转来手术的患者,故此组患者在全麻低温体外循环下完成了先天性心脏病心脏畸形矫治手术,围术期死亡10例(其中术中死亡2例,术后12 d内死亡8例),术后半年内死亡2例,病死率8.39%,失访12例,随访119例存活。结论先天性心脏病合并肺动脉高压,患者如满足以下条件:体循环血流量与肺循环血流量之比(QP/QS)≥1.5,全肺阻力≤800 dynes·s/cm5(10 Wood),氧分压≥70 mm Hg,末梢氧饱和度(Sp O2)≥96%,可以考虑手术治疗,必要时术后早期适当应用缩血管药物,以降低右心做功而维护右心功能,明显提高血管扩张性休克患者生活质量及生存率。
Objective To summarize the experience of perioperative management of patients with congenital heart disease and pulmonary artery hypertension .Methods One hundred and forty-three patients with congenital heart disease and pulmonary artery hypertension in the Second Hospital of Beijing Regional Corps , Chinese People′s Armed Police Forces from March 2007 to June 2014 were enrolled in this study .All patients underwent ultrasonic cardiogram （ UCG ） before the operation , 87 patients underwent right heart catheterization （ RHC） ,and the clinical data were analyzed .Results Most patients were considered not suitable for interventional therapy after consultation , including 51 patients with atrial septal defect , interventricular septal defect , aorticopulmonary fistula or failed after catheter treatment .The patients underwent the correction of congenital cardiac malformations under general anesthesia , hypothermic cardiopulmonary bypass .10 patients died in the perioperative surgery period （ 2 patients died during the operation and the other 8 patients died in 12 days after the operation）,2 cases died after half a year,119 cases survived in the follow-up.Total motality rate was 8.39%except for 12 cases lost in follow-up.Conclusion The patients with congenital heart disease and pulmonary artery hypertension are considered for surgery if such conditions exist： the ratio of pulmonary blood flow volume to systemic blood flow volume （ QP/QS） is no less than 1.5 in RHC,pulmonary vascular resistance is not greater than 800 dynes＆#183; s/cm5（10 Wood）,partial pressure of oxygen is no less than 70 mmHg and the rate of saturation of peripheral oxygen is no less than 96%.It is necessary to apply vasocontrictor drugs early in order to maintain the＆amp;nbsp;function of right heart by alleviating its work .The use of vasocontrictor drugs increases the survival rates of vasodilatory shock patients significantly and makes a good recovery after surgery , the patients′quality of life and survival rates wi
出处
《心血管外科杂志（电子版）》
2015年第1期15-19,共5页
Journal of Cardiovascular Surgery(Electronic Edition)
关键词
心脏缺损
先天性
高血压
肺性
心脏外科手术
围术期
Heart defects,congenital
Hypertension,pulmonary
Cardiac surgical procedures
Perioperative surgery periods
