37例室间隔缺损并重度肺动脉高压外科治疗  

Surgical Treatment of Ventricular Septal Defect with Severe Pulmonary Hypertension in 37 Patients

作　　者：刘桂清[1] 马增山[1] 马胜军[1] 董铭锋[1] 柴守栋[1] 郭英华[1] 

机构地区：[1]山东省聊城市人民医院心外科,山东聊城252000

出　　处：《中国医师杂志》2002年第7期727-728,共2页Journal of Chinese Physician

摘　　要：目的　总结 37例室间隔缺损并重度肺动脉高压手术治疗经验。方法　 37例经手术治疗的室间隔缺损合并重度肺动脉高压的患者应用包括休息、吸氧、口服卡托普利及静滴前列腺素E1等在内的降肺动脉压综合治疗 ,治疗后若杂音增强 ,血氧饱和度升高 ,心脏彩超示左向右分流增加则手术 ,若变化不明显 ,重复用药。全组病例均在中度低温体外循环下手术修补缺损。分别观察术前术后全组病例的血氧饱和度、肺动脉压以及心功能情况 ,随访心功能的改善情况及死亡率。结果　术后 2例死于低心排 ,1例死于呼吸衰竭 ,其他病例恢复顺利。经随访 ,1例患者于术后 8月死亡 ,其他患者心功能均有明显改善。结论　合理的围手术期治疗及严格掌握手术适应症是降低室间隔缺损合并重度肺动脉高压死亡率的关键因素 ,血氧饱和度可作为判断是否手术的简单易行的指标。Objective To summarize the operative experience of ventricular septal defect(VSD) with severe pulmonary hypertension(PH).Methods 37 patients with VSD complicated with severe PH,who underwent surgical repair were treated combinatively in perioperative period including resting,oxygen inhalation,and administration of captoprill and prostaglandin E 1(PGE 1).All of the patients were operated by cardiopulmonary bypass with moderate hypothermia.Arterial oxygen saturation(SaO 2),pulmonary arterial pressure and cardiac function were observed before and after operation,and progression of cardiac function and mortality were followed-up after discharged.Results 2 patients died of low cardiac output syndrome(LCOS) and one patient died of respiratory failure,and the operative mortality was 8 1%.one patient was diad after 8 months and the cardiac function of 33 patients markedly improved.Conclusions Reasonable treatment in perioperative period and holding the indications for the operation strictly are the keys to decrease the mortality of the operation,and SaO 2 could be a simple measurement to identify the indication of operation and the prognosis of the patient with VSD complicated with severe PH.

关 键 词：外科治疗 室间隔缺损 肺动脉高压 动脉血氧饱和度 

分 类 号：R654.2[医药卫生—外科学]