单向活瓣补片在先天性心脏病合并重度肺动脉高压患者外科治疗中的应用  

Application of unidirectional valved patch in surgical treatment of congenital heart disease patients with severe pulmonary hypertension

作　　者：徐盛松[1] 石开虎[1] 张飞[1] 

机构地区：[1]安徽医科大学第二附属医院心胸外科

出　　处：《安徽医学》2010年第12期1440-1442,共3页Anhui Medical Journal

摘　　要：目的探讨单向活瓣补片在先天性心脏病合并重度肺动脉高压患者外科治疗中的临床应用价值。方法选择47例成人先天性心脏病合并重度肺动脉高压病例,采用单向活瓣补片进行心脏间隔缺损修补,麻醉行深静脉穿刺过程中放置Swan-Ganz漂浮导管监测手术前后肺动脉压（PAP）、肺血管阻力（PVR）、心排量（CO）,另抽取外周动脉血检测动脉氧分压（PaO2）等项指标;手术前后行心脏彩超检查了解心脏间隔缺损状况及肺动脉压、间隔分流变化情况,同时检测PAP变化。结果采用单向活瓣补片修补技术,患者术后早期PAP、PVR即较术前明显减低（P〈0.05）,PaO2、CO增加,随访4~20个月,PAP进一步减低,心功能明显改善。全组除1例因术后低心排死亡外,其余均无肺动脉高压危象或心力衰竭发生。随访中发现2例术后PH持续存在,单向活瓣持续右向左分流,其余44例心脏彩超提示术后1~6个月活瓣关闭（平均3.6个月）、分流消失,PH自术前的（76.81±13.33）mmHg降至（37.23±9.46）mmHg（P〈0.01）。结论应用单向活瓣补片修补技术能显著降低先天性心脏病合并重度肺动脉高压病例的手术风险。Objective To investigate the clinical value of unidirectional valved patch on treating congenital heart disease with severe pulmonary hypertension（PH）.Methods From October 2008 to August 2010,47 cases of adult congenital heart disease with severe pulmonary hypertension were selected as samples.There cardiac defects were repaired with unidirectional valved patch.Swanz-Ganz float catheter was placed to detect the alleosis of PAP、PVR、CO and PaO2 in pre-and-post operations.Ultrasonic Cardiogram（UCG） was used to monitor the change of cardiac defect,the shunt and the PAP.Follow ups were conducted within 4 to 20 months（average 10.3 months）.SPSS10.0 soft was used to analyze the data.Results In prophase,PAP、PVR decreased significantly（P0.05） and PaO2、CO raised after operation when unidirectional valved patch was used.PAP was found decreased further and heart function improved significantly during the follow ups within 4 to 20 months.Except for 1 case died due to low cardiac output after surgery,there was no pulmonary hypertensive crisis or heart failure happened.During the 4-20 months of follow up,2 cases were found having consistent PH and persistent right-to-left shunting.There was no shunting or PH found in other 44 cases.UCG showed that unidirectional valve closed completely and shuntings disappear within 1 to 6 months after operation average 3.6 monthes）.Conclusion Closure of cardiac defect in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a unidirectional valved patch was used and the long-term result was satisfactory.

关 键 词：心脏外科手术 心脏间隔缺损 肺动脉高压 单向活瓣补片 

分 类 号：R654.2[医药卫生—外科学]