缩血管药物在先天性心脏病合并重度肺动脉高压患者围手术期的应用  

The perioperative application of vasoconstrictor in patients of congenital heart disease with sever pulmonary arteries hypertension

作　　者：李书闻[1] 贾清彦[1] 欧阳川[1] 程卫平[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,100029

出　　处：《中华胸心血管外科杂志》2012年第7期425-428,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨围手术期应用血管活性药物对先心病伴重度肺动脉高压患者（儿）的疗效。方法32例患者（儿）随机分成两组，每组16例。一组使用传统的治疗方法，应用血管扩张药扩张肺动脉，降低肺阻力；另一组以减少右心做功为目标，通过应用缩血管药物，维持正常的血管阻力和心排出量，降低右心做功，减少右心衰的发生。分别记录并比较两组血流动力学参数、右心做功、呼吸机使用时间及术后并发症等指标之间的差别。结果畸形纠正后使用缩血管药物组与使用扩血管药物组相比结果如下：主、肺动脉压力倒置6．25％对56．25％；右心衰发生率6．25％，对93．75％；术后呼吸机应用时间（68．00±7．17）h对（115．00±13．68）h；ICU停留时间（5．0±0．8）天对（8．0±1．5）天；术后肺部并发症的发生率6．25％对81．25％；病死率0对12．5％。结论通过应用缩血管药物，恢复外周血管阻力、维持适当的心排量、降低右心做功、维护右心功能为目标的新治疗理念能减少术后并发症的发生率，明显降低病死率。Objective To compare the curative effects of different ideas for application of vasoactive drugs in patients of congenital heart disease with SPAH during perioperative period and to choose a method to improve the survival rate of patients with high-risk SPAH. Methods Thirty two patients were separated into two groups randomly, one group was treated by vasodilator to dilate the pulmonary artery and decrease the pulmonary pressure as conventional therapeutic strategy, the other was treated by vasoactive drugs to decrease the right cardiac output, which maintain the normal vessel resistance and cardiac output and reduce right heart failure. Indexes wet~ recorded respectively, including hemodynamic, right cardiac working index（ RCWI）, the time of using respirator and postoperative complications to compare the differences. Results Indexes were recorded in two groups as follewing ： Aortic/puhnonary, artery pressure inversion （6.25 % vs. 56.25 % ）, RCWI （ 1626. 87 ± 411.23 vs. 3808. 99 ±275.52 ）, incidence of right heart failure （ 6.25% vs. 93.75% ） , respirator applying time [ （ 68.00 ± 7. 17 ） h vs. （115.00 ±13.68） hi, ICU time[ （5.0 ±0.8） d vs. （8.0 ± 1.5） d] ,incidence of postoperative puhnonary complications （6.25% vs. 81.25% ） ,mortality（0 vs. 12.5% ）. Conclusion The new therapeutic idea that using vasoactive drugs to reduce RCWI and to maintain peripheral vessel resistance and appropriate cardiac output is supenor for postoperative complications and mortality reduction.

关 键 词：先天性心脏病 肺动脉高压 缩血管药物 体循环阻力 

分 类 号：R654.2[医药卫生—外科学]