先天性心脏病合并重度肺动脉高压的诊断性治疗  

The diagnostic treatment in congestive heart disease associated with severe pulmonary arterial hypertension

作　　者：李寒[1] 贝亚军[1] 汤楚中[1] 张载高[1] 迟海涛[1] 潘绪[1] 解水本[1] 

机构地区：[1]海军总医院心脏中心,北京100048

出　　处：《北京医学》2012年第7期539-541,共3页Beijing Medical Journal

摘　　要：目的探讨先天性心脏病(简称先心病)合并重度肺动脉高压患者手术指征的判断及围手术期治疗策略。方法总结2008年1月至2011年12月海军总医院收治的先心病合并重度肺动脉高压患者83例,其中室间隔缺损65例,房间隔缺损8例,动脉导管未闭5例,右室双出口3例,主动脉缩窄及主动脉弓离断各1例,给予强心、利尿、选择性扩张肺动脉的药物治疗;选择同期16例患者为对照组,仅给予强心、利尿治疗。监测末梢血氧饱和度变化,以氧饱和度稳定在95%以上为标准,判断手术指征。结果治疗组手术64例(77.1%),围手术期死亡2例,无远期死亡患者。对照组手术5例(31.3%),远期死亡1例。结论通过药物对重度肺动脉高压患者进行诊断性治疗,可以对肺动脉高压性质做出准确的判断,判断手术指征,降低手术死亡率,获得良好的疗效。Objective To evaluate the operative indications and the perioperative management of congestive heart disease complicated with severe pulmonary hypertension. Methods From January 2008 to December 2011, 83 patients suffered congestive heart disease associated with severe pulmonary hypertension including ASD, VSD, PDA and DORV, were prescribed selective pulmonary vasodilator drugs. Sixteen patients in the control group were treated without these drugs. Operative indications were based on the changes of SpO 2 , echocardiogram and X-ray. Results After the pre-operative preparation, 65（77.1%） operations were performed. one patient died 6 days after the operation; only 5 （31.2%）operations were performed in the control group and no patient died. The follow-up showed that the pulmonary pressure was significantly decreased. Conclusion Satisfactory results can be achieved in the treatment of congestive heart disease with severe pulmonary hypertension by preoperative analysis of surgical indications.

关 键 词：先天性心脏病 肺动脉高压 诊断性治疗 

分 类 号：R654.2[医药卫生—外科学]