单向活瓣补片在合并重度肺动脉高压的先天性心脏病患者手术治疗中的应用  

Application of one-way valved patch in treatment of patients with congenital heart disease with severe pulmonary hypertension

作　　者：庞昕焱[1] 李卫华[1] 宋惠民[1] 苏润毅[1] 于建华[1] 李跃华[1] 毕研文[1] 李守先[1] 

机构地区：[1]山东大学齐鲁医院心外科,济南250012

出　　处：《中华医学杂志》2004年第11期888-890,共3页National Medical Journal of China

摘　　要：目的　探讨应用单向活瓣补片对合并重度肺动脉高压的先天性心脏病 (先心病 )患者的手术治疗方法及效果。方法　采用单向活瓣补片对 38例伴有重度肺动脉高压的先心病患者进行手术治疗及术后随访观察。结果　术后 11例肺动脉压力下降明显 ,未出现跨单向活瓣补片的分流 ;余2 7例术后 72h内出现分流 ,其中 1例术后 72h死于低心排出量 ,1例术后 4周死于右心衰竭 ;36例康复出院。术后出现分流的 2 7例患者 2 2例随访 6～ 86个月 ,其中术后 3个月仍出现跨单向活瓣补片分流 7例 ,右向左分流 4例 ,双向分流 3例 ;术后半年以上仍存在经单向活瓣补片分流 4例 ,其中 3例肺动脉收缩压 (PP) /主动脉收缩压 (PS)仍 >0 75 ,2例右向左分流 ,1例双向分流 ;另 1例PP/PS降至0 4 5 ,存在 3mm跨单向活瓣补片左向右分流 ;11例术后未出现跨单向活瓣补片分流者 ,术后 3个月复查示肺动脉压力下降满意 ,无跨单向活瓣补片分流。 2 2例中 19例自觉症状及生活质量较术前改善明显。结论　对于合并重度肺动脉高压的先心病应用单向活瓣补片进行手术修补 ,可使当术后右心压力增高时右心血流可通过单向活瓣补片活瓣孔分流到左心系统 ,为右心起到分流减压作用 ,同时以可以耐受的体循环血氧饱和度降低为代价增加左心系统血容量 ,保证左心排?Objective To explore the effect of one way valved patch used in congenital heart disease with severe pulmonary hypertension Methods One way valved patch was used in 30 patients of congenital heart disease with severe pulmonary hypertension (PP/PS>0 75) in operation. Follow up of 6～86 months was conducted to observe its effect Results The pulmonary artery pressure was significantly decreased without trans patch shunt in 11 cases postoperatively Trans patch shunt was determined in 27 cases within postperative 72 hours There were 2 postoperative deaths out of these 27 patients: one died of low cardiac output syndrome 72 hours after operation, and the other died of right heart failure 4 weeks after operation Thirty six patients were restored to health and discharged.Three month follow up showed trans patch shunt in 7 cases,including right to left shunt in 4 cases and two side shunt in other 3 cases Color Doppler ultrasonography conducted 6 months after operation proved trans patch shunt in 4 cases, right to left shunt in 1 case , two side shunt in 2 cases , and left to right shunt in 1 case (PP/PS=0 45) Conclusion One way valve d patch is useful in selected patients in which postoperative right heart failure can be anticipated so as to shunt the blood in the right heart to the left heart and increase the blood volume in the left heart system to ensure the left heart output and minimize the risk of postoperative right heart failure, at the expense of systemic low oxygen saturation that is, however, well tolerated

关 键 词：单向活瓣补片 重度肺动脉高压 心血管疾病 先天性心脏病 手术治疗 心间隔缺损 

分 类 号：R654.2[医药卫生—外科学]