摘要
目的 探讨围手术期经左心房导管应用去甲肾上腺素对先天性心脏病合并重度肺动脉高压患者的疗效.方法 收集我院择期在体外循环下行先天性心脏病修复术患者40例,患者均合并重度肺动脉高压.将患者随机分为2组（n=20）：对照组（C组）和左心房导管输注去甲肾上腺素组（L组）.C组与L组均在心脏复跳后经中心静脉导管持续泵人多巴胺、多巴酚丁胺、肾上腺素、硝酸甘油,与此同时L组经左心房导管输注去甲肾上腺素.记录并行循环（T1）、CPB停机后15 min（T2）、术毕（T3）、术后24 h（T4）各时间点各组血流动力学参数、血乳酸数值.观察术后患者主、肺动脉压力倒置率、右心衰发生率、机械通气时间、ICU停留时间、术后肺部并发症发生率和病死率.结果 将C组与L组术后主、肺动脉压力倒置率（11例比1例）;右心衰发生率（16例比1例;80％：5％）;机械通气时间[（123.00±13.50）h比（76.00±7.25） h];ICU停留时间[（8.00±1.60）d比（5.00±0.70）d];术后肺部并发症发生率（14例比2例;70％：10％）;病死率（2例比0例;10％：0％）进行比较,并经统计学分析后得出,L组数值均低于C组（P＜0.05）.结论 通过左心房导管输注去甲肾上腺素这一治疗方法来维护适当的心排血量和外周血管阻力,能有效减少先天性心脏病合并重度肺动脉高压患者术后并发症的发生,降低患者死亡率.
Objective To evaluate the curative effects of using norepinephrine through the catheterization of left atrium in patients of congenital heart disease with sever pulmonary arteries hypertension （SPAH） during perioperative period.Methods Forty pediatric patients of both sexes scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly diveded into 2 groups（n =20 each）：control group （C group） and transfusing the norepinephrine through the catheterization of left atrium group （L group）.After the cardiac resuscitation,C and L groups were continuous given infusion of dopamine,dobutamine,epinephrine,nitroglycerin and at the same time the L group were transfused the norepinephrine through the catheterization of left atrium.The hemodynamic parameters,blood lactate values of each group at parallel loop （T1）,15 min after CPB shutdown （T2）,end of the surgery （T3）,24 h after the surgery （T4） were recorded.The main and pulmonary artery pressure inversion rate of the patients,the incidence of right heart failure,duration of mechanical ventilation and duration of stay in intensive care unit,the the incidence of postoperative pulmonary complications,mortality were also recorded.Results In group C and L,the main and pulmonary artery pressure inversion rate of the patients were 55% and 5%,the incidence of right heart failure were 80% and 5%,the duration of mechanical ventilation were （123.00 ± 13.50） h and （76.00 ±7.25） h,the duration of stay in intensive care unit were （8.00 ± 1.60） d and （5.00 ± 0.70） d,the incidence of postoperative pulmonary complications were 70% and 10%,and the mortality were 10% and 0%.Compared with C group,the results of group L were much belower （P 〈 0.05）.Conclusion The therapeutic idea that using norepinephrine through the catheterization of left atrium to maintain adequate cardiac output and peripheral vascular resistance is superior for postoperative complications and mortality reduction in patients of congenital heart disease with SPAH after operation.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2014年第2期438-440,共3页
Chinese Journal of Experimental Surgery
关键词
导管置入术
左心房
去甲肾上腺素
先天性心脏病
肺动脉高压
Catheterization
Left atrium
Norepinephrine
Congenital heart disease
Pulmonary arteries hypertension
