先天性心脏病合并艾森曼格综合征的外科治疗  

Sugical treatment of congenital heart diseases with Eisenmanger syndromeSugical treatment of congenital heart diseases with Eisenmanger syndrome

作　　者：张学勤[1] 张伟[1] 江萍[1] 常飞虎[1] 

机构地区：[1]吉林省人民医院心脏外科,长春市130021

出　　处：《中国心血管病研究》2012年第3期168-171,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的回顾分析28例先天性心脏病合并艾森曼格综合征患者外科手术结果，评价手术治疗效果，探讨手术适应证。方法所有病例术前均予以靶向降肺动脉压为主的综合治疗，以动脉SaO2≥90％作为手术指征进行手术。结果围术期无死亡，术后随访4～24个月。1例出院后2个月猝死于肺高压危象；2例患者随访结果欠佳，心功能Ⅳ级，其中1例术后经常晕厥，反复咯血，1例术后3个月肺动脉高压右心衰伴三尖瓣大量反流。其余25例患者均较术前有不同程度的改善。结论部分以往被列为手术禁忌的艾森曼格患者仍可经充分靶向治疗后获得手术机会，并可拥有一个满意的预期结果。正确的手术适应证以及手术时机的选择，合理的围手术期处理，术后长期靶向药物治疗是降低手术风险、改善预后的关键。Objective To summarize the surgical curative effect by retrospectively reviewing the clinical outcomes of 28 congenital heart disease patients with Eisenmenger syndrome at our hospital. Methods All cases were given combined therapy targeted at pulmonary pressure before operation and select the cases whose SaO2 ≥ 90% as surgical indication. Results There were no death in pre-operation period and one case succumbed to pul- monary hypertension crisis two months post-operation. The outcome of two eases were unsatisfied with heart func- tion IV level during the follow-up period（4-24 months） including one with repeated syncope and hemoptysis, one with right heart failure and tricuspid valve massive regurgitations because of pulmonary hypertension three months post-operation. The condition of all the other patients were improved at different degree. Heart function improved to I level in 9 cases, 10 cases to II level and 6 cases around at m level with midrange pulmonary hypertension. Conclusion Part patients with Eisenmenger syndrome that be regard as surgical contraindication still have a chance for operation after sufficient targeted therapy. Making a correct selection of patients, a rational pre-operation treatment and long-time targeted therapy after operation is the key point of reducing surgery risks and improving prognosis.

关 键 词：先天性心脏病 艾森曼格综合征 

分 类 号：R654.2[医药卫生—外科学]