肺动脉高压先天性心脏病患者降肺动脉压的预后效果  

Prognosis of reducing pulmonary artery pressure in patients with congenital heart disease complicated with pulmonary hypertension

作　　者：夏琨[1] 孙东明[1] 王瑞耕[1] 尹薇[1] 刘玲[1] 

机构地区：[1]武汉市儿童医院心血管内科,湖北武汉430016

出　　处：《重庆医学》2016年第30期4265-4266,4270,共3页Chongqing medicine

摘　　要：目的探讨先天性心脏病(CHD)合并肺动脉高压(PAH)患者行降肺动脉压治疗的安全性及疗效。方法选择2014年9月至2015年1月在该院治疗的CHD合并PAH患者34例,均在常规治疗的基础上增加内皮素受体拮抗剂波生坦治疗,观察患者行降动脉压治疗后血流动力学、心功能检测和6min步行距离试验(6 MWD)情况。结果治疗后患者肺血管阻力(PVR)、股动脉血氧饱和度(SaO2)、肺循环/体循环血流量比值(Qp/Qs)和右心输出量(CO)分别为(218.30±91.25)dyn·s-1·cm-5、(95.16±7.84)%、(1.10±0.27)和(5.20±1.36)L/min,均较治疗前有所改善(P<0.05);治疗前后肺动脉收缩压(sPAP)、肺动脉舒张压(dPAP)、平均肺动脉压力(MPAP)、心率(HR)和中心静脉压(CVP)比较,差异均无统计学意义(P>0.05);治疗前后右心室直径(RVD)、左心室射血分数(LVEF)、三尖瓣返流速度(VP)、三尖瓣跨瓣压差(PGTV)、左心室舒张末容积(LVEDV)和左心室舒张末直径(LVEDD)比较,差异均无统计学意义(P>0.05);治疗后3、6个月6 MWD步行距离分别为(378.09±40.12)、(423.07±35.32)m,均较治疗前提高,差异有统计学意义(P<0.05)。结论 CHD合并PAH患者行波生坦治疗安全有效,能改善肺血流动力学和6 MWD。Objective To investigate the safety and efficacy of reducing pulmonary arterial pressure in patients with congenital heart disease（CHD）complicated with pulmonary hypertension（PAH）.Methods From September 2014 to January 2015 in our hospital,34 patients with CHD complicated with PAH were selected,all of them were treated with endothelin receptor antagonist,bosentan,on the basis of conventional therapy.The hemodynamics observation,cardiac function detection and six-minute walking distance test（6 MWD）were performed after pulmonary artery pressure reducing therapy.Results After treatment,the pulmonary vascular resistance（PVR）,arterial oxygen saturation（SaO2）,Qp/Qs and right cardiac output（CO）in these patients was（218.30±91.25）dyn·s-1·cm-5,（95.16±7.84）%,（1.10±0.27）and（5.20±1.36）L/min,respectively,which were better than those before treatment（P〈0.05）.There was no statistically significant difference in the pulmonary artery systolic pressure（sPAP）,pulmonary artery diastolic pressure pulse AI（dPAP）,mean pulmonary arterial pressure（MPAP）,heart rate（HR）and central venous pressure（CVP）before and after the treatment（P〈0.05）.There was no statistically significant difference in the right ventricular diameter（RVD）,left ventricular ejection fraction（LVEF）,three tricuspid regurgitation velocity（VP）,three tricuspid valve transvalvular pressure difference（PGTV）,left ventricular diastolic volume（LVEDV）and left ventricular diastolic diameter（LVEDD）before and after the treatment（P〈0.05）.After 3months and 6months of treatment,6MWD was（378.09±40.12）and（423.07±35.32）m respectively,both of which were higher than those before treatment,the differences were statistically significant（P〈0.05）.Conclusion The application of bosentan therapy is safe and effective for patients with CHD complicated with PAH,which could improve pulmonary hemodynamics and 6 MWD.

关 键 词：肺动脉高压 先天性心脏病 安全性 临床效果 

分 类 号：R541.1[医药卫生—心血管疾病] R544.1[医药卫生—内科学]