先天性心脏病伴肺动脉高压转流中肺保护的体会  

The experience of lung protection in cardiopulmonary bypass for patients with congenital heart disease and pulmonary hypertension

作　　者：罗海燕[1] 董念国[1] 徐志娟[1] 冯汉萍[1] 金润梅[1] 胡琳[1] 江萍[1] 

机构地区：[1]华中科技大学附属协和医院心外科华中科技大学同济医学院心血管病研究所,武汉430022

出　　处：《临床心血管病杂志》2004年第11期675-676,共2页Journal of Clinical Cardiology

摘　　要：目的 :总结 32 6例先天性心脏病伴肺动脉高压行心内直视术转流中的肺保护体会。方法 :回顾性分析 1999年 9月～ 2 0 0 2年 5月 32 6例先天性心脏病伴肺动脉高压患者的体外循环 ,全部患者均在全麻体外循环下行心内直视术。转流中重点加强肺保护 ,避免增加肺血管阻力的外在因素 ,适当给予扩张肺血管药物。结果 :32 6例患者围手术期死亡 8例 (2 .4 % ) ,其中 5例死于严重低心排 ,2例死于呼吸衰竭 ,1例死于心律失常。在ICU机械辅助呼吸平均 18h ,再次气管插管 5例。结论 :先天性心脏病伴肺动脉高压体外循环中加强肺保护有利于降低肺血管阻力 ,减轻右心负荷 ,缩短呼吸机使用时间 。Objective: To sum up the experience of lung protection in cardiopulmonary bypass for open heart surgery. Method:The 326 patients aged ( 8.25± 0.72)years, with body weight of ( 21.53± 0.93)kg underwent cardiac surgery and general anesthesia and CPB from Sept, 1999 to May, 2002. We avoided any possible factors that increased the pulmonary vascular resistance and administrated the pulmonary vascular dilators to improve the lung protection. Result:Eight cases ( 2.4%) died of early postoperative complications including 5 cases of severe low cardiac output, 2 cases of respiratory failure and 1 case of arrhythmia. The average time of mechanical ventilation was 18 hours and 5 cases were reintubated in ICU. Conclusion:Enhancement of lung protection in CPB for patients with congenital heart disease and pulmonary hypertension decreases pulmonary vascular resistance and the right ventricle afterload, shortens the time of assistant ventilation, lower the mortality of pulmonary hypertension crisis and right heart failure.

关 键 词：心脏缺损 先天性 肺动脉高压 体外循环 肺保护 

分 类 号：R541[医药卫生—心血管疾病]