单向活瓣治疗先天性心脏病合并重度肺动脉高压疗效分析  

Unidirectional valved patch for congenital heart disease with severe pulmonary hypertension

作　　者：伍明[1] 杨进福[1] 杨一峰[1] 胡建国[1] 周新民[1] 刘锋[1] 吴忠仕[1] 赵天力[1] 熊炼[1] 王欣[1] 尹倪[1] 

机构地区：[1]中南大学湘雅二医院胸心外科,长沙410011

出　　处：《中南大学学报（医学版）》2011年第11期1097-1101,共5页Journal of Central South University ：Medical Science

摘　　要：目的:探讨单向活瓣修补技术在先天性心脏病(简称先心病)合并重度肺动脉高压患者手术中的应用及疗效。方法:回顾性分析采取单向活瓣补片技术矫治的37例先心病合并重度肺动脉高压患者的治疗情况,总结其近、中期疗效,以寻求最佳手术治疗方案。结果:本组患者术前彩超示平均肺动脉压(MPAP)为60～72 mmHg;心导管检查:肺动脉压力为80～120 mmHg,肺动脉收缩压/主动脉收缩压(PP/PA)为0.8～1.05,肺血管阻力(PVR)为8.5～19.2(吸氧后6.8～14.6)wood单位。术中撤离体外循环后PP/PA为0.4～0.72,术后彩超复查MPAP为32至48 mmHg;术后无1例出现肺动脉高压危象,无1例死亡;呼吸机带机时间32 h～8 d,脱离呼吸机后静息状况下氧饱和度为93%～96%;跨活瓣分流情况:5 d后彩超复查存在右向左分流者有22例,1个月复查有11例,3个月复查有4例,除1例失访外,分流均在1年内消失。多数患者未作远期随访,仅12例患者随访1年,5例患者随访3年,多数患者仅随访3个月。结论:单向活瓣手术能明显降低先心病合并重度肺动脉高压患者围手术期风险,近、中期疗效理想,但远期疗效有待进一步观察。Objective To explore the effect of unidirectional valved patch（UVP） for congenital heart disease（CHD） with severe pulmonary hypertension（PH）.Methods We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation,and summarized its short-term to mid-term effect to find an optimum therapeutic regimen.Results Before the operation,the ECG showed that the mean pulmonary artery pressure（MPAP） ranged 65-72 mmHg,and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg,PP/PA ranged 0.8-1.05,PVR ranged 8.5-19.2（under oxygen inhalation 6.8-14.6） wood unit.After the operation,PP/PA ranged 0.4-0.72 on weaning-off CPB.Postoperative ECG showed the MPAP ranged 32-48 mmHg.No pulmonary hypertension crisis occurred and no patient died.Mechanical ventilation time ranged from 32 h to 8 d and the SaO2 ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows：22 cases had shunt 5 d after the operation,11 cases had shunt 1 month after the operation,4 cases 3 months after the operation,and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data： 12 patients had a 1-year follow-up,5 patients had a 3-year follow-up,and most patients had just 3-month follow-up.Conclusion UVP can decrease the operative risk in CHD with severe PH at perioperative period.The short-term to mid-term effect is satisfactory,while long-term effect remains uncertain.

关 键 词：先天性心脏病 重度肺动脉高压 活瓣补片 

分 类 号：R654.2[医药卫生—外科学]