浅低温体外循环心脏跳动中手术矫治先心病合并重度肺动脉高压  被引量:9

On-pump, beating-heart intracardiac procedures for congenital heart disease with severe pulmonary hypertension

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作  者:陈林[1] 肖颖彬[1] 王学锋[1] 钟前进[1] 陈柏成[1] 陈进劲[1] 刘兵[1] 曾祥君[1] 

机构地区:[1]第三军医大学附属新桥医院心血管外科,重庆400037

出  处:《第三军医大学学报》2001年第5期505-507,共3页Journal of Third Military Medical University

摘  要:目的 对比分析中低温体外循环心脏停跳和浅低温体外循环心脏跳动中手术矫治先天性心脏病合并重度肺动脉高压的疗效。方法  1 5 3例术中测量肺动脉压 /体循环压 >0 .75的患者 ,采用心脏停跳手术 95例 (停跳组 ) ,其中室间隔缺损 (VSD) 79例 ,房间隔缺损 (ASD) 1 3例 ,动脉导管未闭 (PDA) 3例 ;心脏跳动中手术 5 8例 (跳动组 ) ,其中VSD 43例 ,ASD 1 0例 ,PDA 5例。结果 停跳组早期死亡 1 2例 (病死率 1 2 .6 % ) ,呼吸衰竭作气管切开 8例 (8.4% )。跳动组无早期死亡和气管切开病例。痊愈出院 1 41例 ,随访 3月至 1 0年 ,停跳组 2例术后 6年发生顽固右心衰 ,其余恢复良好。结论 心脏跳动组手术矫治先心病合并重度肺动脉高压的效果明显优于心脏停跳组 。Objective To compare the clinical efficiency of intracardiac procedures on traditional cardioplegic arrested heart and on pump beating heart for congenital heart disease (CHD) with severe pulmonary hypertension. Methods Among all 153 cases, 95 cases underwent operations on cardioplegic arrested heart, while 58 on pump beating heart. In arrested heart group, 79 cases with ventricular septal defect (VSD), 13 with atrial septal defect (ASD) and 3 with patent ductus arteriosus (PDA) were examined while in beating heart group, 43 cases with VSD, 10 with ASD, and 5 with PDA were examined. Results There were 12 cases of operative death (12.6%) and 8 of tracheotomy (8.4%) in heart arrested group. No operative death and tracheotomy in beating heart group. 141 patients were followed up for 3 months to 10 years with good recovery. There were 2 cases of right heart function failure six years later in arrested heart group. Conclusion Results suggest that on pump beating heart technique is superior to traditional cardioplegic arrested heart for CHD with severe pulmonary hypertesion. The cause might be that on pump beating heart intracardiac operation is more effective in cardiopulmonary protection.

关 键 词:心脏跳动中心内直视手术 体外循环 肺动脉高压 

分 类 号:R654.2[医药卫生—外科学] R654.1[医药卫生—临床医学]

 

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