右心旁路手术的肺动脉高压处理  

Treating pulmonary hypertension after right ventricle bypass

作　　者：陶曙光[1] 王建明[1] 杨仕海[1] 韩剑刚[1] 温林林[1] 谷疆蓉[1] 姚俊平[1] 宋海龙[1] 

机构地区：[1]河北省儿童医院心外科,050031

出　　处：《心肺血管病杂志》2015年第11期830-832,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：总结右心旁路手术的肺动脉高压处理经验。方法：回顾分析2012年1月至2015年1月,我院收治的右心旁路手术临床病例,共计62例,其中含肺动脉闭锁、大动脉转位、右心室双出口、单心室、法洛四联症合并完全性房室间隔缺损等,右心旁路手术方法包括双侧双向格林术、单侧双向格林术、改良房探术,其中肺动脉高压需要处理14例,男性8例,女性6例,平均年龄（7.7±4.2）岁（3~17）岁,体质量（20±9.94）（8~47）kg,其中双侧双向格林术（5例）、单侧双向格林术（7例）、改良房探术（2例）,占总数22.6%。经过术中环缩肺动脉,结扎动脉导管,合理应用呼吸机辅助呼吸,术后吸入NO,口服靶向药物,静脉应用前列腺素等处理有效的降低肺动脉压力,改善右心旁路手术效果,改善患儿生活质量。结果：本组14例患儿中,无死亡病例。经过综合处理术后肺动脉压力正常,其中3例双向格林术后患儿,腹壁静脉曲张,活动后气促,易患上呼吸道感染,甚至上肢浮肿明显,术后进行心导管检查,肺动脉测压35mm Hg（1mm Hg=0.133k Pa）、27mm Hg及32mm Hg,经口服靶向药物、吸入NO,逐渐好转至上述症状消失。结论：右心旁路手术如合并肺动脉高压需得到临床重视,并且通过积极处理,可以明显降低肺动脉压力,改善右心旁路手术效果,改善患儿生活质量。Objective： To summarize the treatment of pulmonary hypertension after right ventricle bypass. Methods： From Jan. 2012 to Jan. 2015,14 cases with pulmonary hypertension were treated after right ventricle bypass,male is 8 cases,female is 6 cases,age from 3 years to 17 years,weight from 8kg to 47 kg.There were 5 cases were performed bidirectional Glenn shunt,7 cases were performed Glenn shunt,2 case were performed modified Fontan. All cases＇ pulmonary hypertension were treated by banding pulmonary artery,lagition patent ductus arteriosus,with alprostadil,with NO. There have high clinical effective on the treatment of pulmonary hypertension. Results： NO cases died in the postoperative period. Conclusion： The pulmonary hypertension must be treated,and it is of great importance for preventing an elevation of pulmonary arterial pressure and improving patient outcomes.

关 键 词：右心旁路手术 肺动脉高压 先天性心脏病复杂畸形 

分 类 号：R54[医药卫生—心血管疾病]