双心房输注血管活性药物治疗术后先天性心脏病合并肺动脉高压患儿  

Hemodynamic study on biatriai infusion of vasoactive drugs in children with congenital heart disease combined with pulmonary hypertension after operation

作　　者：陈忠建[1] 翟波[1] 王鹏高[1] 杨房[1] 董向阳[1] 陈振良[1] 崔亚洲[1] 

机构地区：[1]郑州市儿童医院胸心外科,450000

出　　处：《中华胸心血管外科杂志》2015年第7期394-396,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨经双心房输注血管活性药物在先天性心脏病合并肺动脉高压患儿术后应用的优点和可行性。方法随机抽取合并肺动脉高压的先天性心脏病90例。一组（45例）经双心房给药，左心房主要输入儿茶酚胺类，右心房输注针对性较强的扩张肺血管药物，如前列腺素E1；另一组（45例）通过中心静脉经右心房给儿茶酚胺类及扩张肺血管药物。以热稀释法测量心排血量（CO）和心指数，计算体循环阻力、肺血管阻力（PVR），经统计学处理后，对该方法进行分析评价。结果全组患儿术后早期（1周内）死亡3例，均为中心静脉给药组；另有2例完全性肺静脉异位引流术后患儿发生了低心排，1例经左心房给药，另1例经中心静脉给药，经治疗痊愈。无远期死亡。两组患儿体外循环时间及阻断时间无显著差异，血管活性药物的量和时间均无差异（P〉0．05）。结论经双心房输注血管活性药物可明显降低平均肺动脉压及PVR，并可增加CO，较传统的中心静脉给药效果好，对先天性心脏病合并肺动脉高压患儿的治疗有非常重要的意义。双心房给药方法安全可行。Objective To investigate the merit and feasibility of vasoactive drugs by the double atrial infusion in children with congenital heart disease combined with pulmonary hypertension, Methods Ninety cases of congenital heart disease combined with pulmonary hypertension were randomly selected. One group（45 cases） was infused by double atrialadministration , which left atrium for eatecholamines,and right atrial infusion for highly targeted expansion of pulmonary vascular drugs, such as prostaglandin El. Another group（45 cases） was infused through the right atrium by a central venous to cateeholamines and pulmonary vascular dilatation drugs . Cardiac output（CO） and cardiac index were measured by thermal dilution method and systemic vascular resistance and pulmonary vascular resistance（PVR） were calculated. Results Three cases were dead in early postoperative period（ 1 week）, which were central intravenous group. 2 cases with total anomalous pulmonary venous drainage had low co after operation, include 1 ease through the left atrium, and the other case through central venous administration, and were recovered. There was no long-term mortality. There was no significant difference in CPB time, blocking time, the amount and timing of vasoactive drugs in two groups （ P 〉 0. 05 ）. Conclusion Double atrial infusion of vasoaetive drugs can significantly reduce the mean pulmonary artery pressure and pulmonary vascular resistance, and increase CO, which is better than the traditional central intravenous methods. The treatment method is of very important significance. Thus double atrial infusion is safe and feasible.

关 键 词：双心房 肺动脉高压 儿茶酚胺 婴幼儿 

分 类 号：R541.1[医药卫生—心血管疾病]