卡托普利对左向右分流先天性心脏病肺动脉高压患者的血液动力学作用  

THE INFLUENCES OF CAPTOPRIL ON THE HEMODYNAMICS FOR THE PATIENTS OF CONGENITAL DISEASE SHUNTINTG FROM LEFT TO RIGHT COMBINED WITH PULMONARY HYPERTENSION

作　　者：罗学群[1] 林红[1] 覃有振[1] 李运泉[1] 魏民新[1] 陆堃[2] 

机构地区：[1]中山医科大学附属第一医院心血管医学部,广州510080 [2]中山医科大学附属第一医院超声心动图室

出　　处：《中国现代医学杂志》2000年第1期10-11,13,共3页China Journal of Modern Medicine

基　　金：广东省卫生厅科研基金资助课题

摘　　要：目的 :了解卡托普利对左向右分流先天性心脏病肺动脉高压患者的血液动力学影响。方法 :心内左向右分流肺动脉平均压 >2 7kPa的患者 30例 ,卡托普利 0 4～ 0 6mg kg(不大于 12 5mg) ,每日 3次 ,服药前及 3～ 5d后用多普勒超声心动图观察血液动力学指标。结果 :发现用药后出现两种不同的血液动力学变化 ,肺 体循环总阻力比值 (TPR TSR)较低的A组用药后主动脉压及体循环总阻力下降 ,肺动脉压及肺总阻力不变 ,TPR TSR升高 ,肺 体循环血流量比值 (Qp Qs)减少 ,而TPR TSR较高的B组主动脉及肺动脉压均降低 ,体循环总阻力无明显变化 ,肺总阻力降低 ,TPR TSR下降 ,Qp Qs增高。临床上A组比B组症状改善更明显。结论 :提示应将心内左向右分流量的变化列为用药后的观察指标 ,特别是对于大分流量有症状的患者 。Objective:To study the influences of Captopril on the hemodynamics for the patients of congenital heart disease shunting from left to right combined with pulmonary hepertension. Methods:30 patients of intracordial shunting from left to right with more than 2.7kPa of mean pulmonary arterial pressure were taken Captopril 0.4 ～ 0.6mg/kg (no more than 12.5mg ) three times per day,Color Doppler Ultrasound Echocardiography was adopted to observe the hemodynamic changes fore and after 3～5 days of taking medicine.Results:In the group A with lower ratio of total pulmonary circular resistance and total systemic circular resistance (TPR/TSR),the aortic pressure and TSR decreased with unchanged pulmonary circular resistance and total systemic circular resistance (TPR/TSR),the aortic pressure and TSR decreased with unchanged pulmonary arterial pressure and TPR,TPR/TSR increased,the ratio of the quantity of blood flow in pulmonary circulation and that in systemic circulation (Qp/Qs) decreased after taking Captopril.But in the group B with higher TPR/TSR,both the aortic pressure and the pulmonary arterial pressure decreased without obvious changes of TSR, TPR and TPR/TSR decreased,Qp/Qs increased after taking Captopril. The clinical symptoms in group A improved obviously that that in group B.Conclusions:The results suggest that the changes of shunting quantity from left to right should be ranked among the observation items. Especially for the patients with large shunting quantity and obvious symptoms,it is neccessary to monitor and evaluate the hemodynamic changes fore and after taking medicine.

关 键 词：先天性心脏病 肺动脉高压 卡托普利 超声心动图 

分 类 号：R543.2[医药卫生—心血管疾病]