摘要
目的探讨先天性心脏病合并重度肺动脉高压的外科治疗。方法选择先天性心脏病合并重度肺动脉高压患者32例。动脉血氧饱和度0．84～0．94，左向右分流20例，双向分流10例，无分流2例。测肺动脉压65～120（82±14）mmHg（1mmHg=0．133kPa）。所有病例均在体外循环下行心内畸形矫治手术，术前给予吸氧、西地那非等治疗，术中应用乌司他丁及低温肺保护液肺动脉灌注等手段，术后常规应用血管活性药物。结果32例手术顺利，术后肺动脉压下降20～40mmHg。30例治愈出院，2例术后早期死于严重低心排血量综合征及致命性心律失常，病死率为6．25％（2／32）。结论先天性心脏病合并肺动脉高压经围手术期综合治疗后再行手术根治可获得良好的临床效果。
Objective To explore the surgical treatment of congenital heart disease combined with severe pulmonary hypertension. Methods Thirty-two patients of congenital heart disease combined with severe pulmonary hypertension were included in the study. The saturation of arterial oxygen ranged from 0.84 to 0.94 and echocardiography showed left to right slow velocity shunt in 20 cases, double direction shunt in 10 cases and no shunt in 2 cases. The pulmonary arterial pressure was 65-120 （82 ±14 ）mm Hg （ 1 mm Hg = 0.133 kPa）. All patients received surgical repairs under eardiopulmonary bypass and were treated preoperatively with oxygen inhalation therapy, oral intake of beraprost sodium or silaenafil respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass,pulmonary artery perfusion was performed with protective solution containing ulinastatin for lung protection. Vasoactive drugs were routinely administrated postoperatively. Results Thirty-two cases underwent the surgical treatment successfully with their postoperative pulmonary arterial pressure decreased 20 -40 mm Hg and 2 cases died of severe low cardiac output syndrome and fatal arrhythmia. The mortality was 6.25%（2/32）. Conclusion Comprehensive perioperative management followed by radical operation can achieve a good clinical result on congenital heart disease combined with pulmonary hypertension.
出处
《中国医师进修杂志》
2012年第2期7-9,共3页
Chinese Journal of Postgraduates of Medicine
关键词
心脏病
高血压
肺性
外科治疗
Heart disease
Hypertension,pulmonary
Surgical treatment
作者简介
通信作者．石开虎，Email：shikaihu@gmail．com
