摘要
目的探讨先天性心脏间隔缺损并重度肺动脉高压(PH)患儿的外科治疗方法及疗效。方法选择本院2003年7月-2007年6月23例先天性心脏病并重度PH病例,全部采用单向活瓣补片进行心脏间隔缺损修补,术中留置肺动脉内置管泵入前列腺素E1(PGE1),并二尖瓣明显返流者同期行二尖瓣成形术,三尖瓣返流者行Devega缩环成形术。术后采用超声心动图监测分流情况,并比较患儿术前、术后肺动脉压(PAP)及血气分析指标变化。采用SPSS10.0软件进行统计学分析。结果患儿术后平均系统血压与术前比较无显著性差异,而PAP较术前明显下降,血气指标较术前有明显改善;肺动脉内持续应用PGE1降低PAP效果显著;随访发现1例术后持续PH存在,单向活瓣持续右向左分流,余22例分别于手术后第3～6个月活瓣关闭、分流消失。结论单向活瓣补片修补缺损、肺动脉内置管泵入PGE1能明显降低PAP,改善血气指标,增加围手术期安全性,同期行必要的瓣膜成形术有利于降低PAP,心脏间隔缺损并重度PH应严格把握手术适应证。
Objective To evaluate the effective of surgical treatments on congenital heart defects with severe pulmonary hypertention （PH）. Methods During operations,23 cases of cardiac defect were repaired with unidirectional valved patch and intered catheters in order to inject prostaglandin E1 （PGE1） into pulmonary artery, and monitor pulmonary artery pressure（PAP） after operation,and cases with mitral incompetence（MI） were treated with mitral valve annuloplasty. Ultrasonic cardiogram （UCG） were used to monitor shunt penetrating the patch. PAP and Pa （ O2 ） were compared between pre - and post - operation. SPSS 10.0 software was used to analyze the data. Results After operation, mean system blood pressure （mSBP） was not different with that of pre - operation. PAP and pa （ O2 ） improved significantly than that of pre - operation. Directly injecting PGE1 into pulmonary artery continuosely could cut down PAP significantly. And persistent right - to -left shuntings were founded penetrating unidirectional valved patch in 1 case with consistent PH and there were no shuntings spontaneously or piecemeally in other 22 cases. Conclusions Cardiac septal defect with irreversible PH is not suitable for repairment. Unidirectional valved patch repairing and injecting PGE1 in pulmonary artery directly can cut down PAP and improwe patients＇ survival. Unidirectional patch shunt blood to left ventricle from right ventricle while severe PH occurs. The shunt disapper when PAP degrade. Valve annuloplasty can degrade PH in cases with valve incompetence.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第11期835-837,共3页
Journal of Applied Clinical Pediatrics
关键词
心脏间隔缺损
先天性
单向活瓣补片
前列腺素E1
瓣膜成形术
cardiac septal defect, congenital
unidirectional valve patch
prostaglandin E1
Valve annuloplasty
