肺动脉环缩术在先天性心脏病合并肺动脉高压患儿中的应用  

Effect of pulmonary artery banding on children with congenital heart disease complicated with pulmonary artery hypertension

作　　者：乔飞[1] 李刚[1] 张晗[1] 刘承虎[1] 许耀强[1] 苏俊武[1] 刘迎龙[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,100029

出　　处：《中国医药》2017年第9期1314-1317,共4页China Medicine

基　　金：国家自然科学基金（81570443）;北京市自然科学基金（7164252）

摘　　要：目的探讨肺动脉环缩术（PAB）在先天性心脏病合并肺动脉高压（PAH）患儿中的应用，对比不同心脏畸形中应用的手术效果，总结PAB术前应用强心利尿靶向药物的经验。方法回顾性分析2010年8月至2016年3月于首都医科大学附属北京安贞医院小儿心脏中心行PAB治疗的98例先天性心脏病合并PAH患儿的临床资料。根据心脏畸形类型将患儿分为单心室矫治组（52例）和延迟根治组（46例），比较2组手术前后肺动脉收缩压（sPAP）及脉搏血氧饱和度（SpO2），分析2组手术效果。结果13例患儿（单心室矫治组10例、延迟根治组3例）就诊时行强心利尿靶向药物治疗。全组患儿PAB术后sPAP及Sp02均明显低于术前[单心室矫治组：（284-8）mmHg（1mmHg=0．133kPa）比（59±20）mmHg、（79±6）％比（90±6）％；延迟根治组：（27±11）mmHg比（53±14）mmHg、（88±7）％比（97±4）％]，差异均有统计学意义（均P〈0．05）。全组死亡3例，病死率为3．1％（3／98），2例术后再次调整环缩带，2例并发心包积液，经治疗后痊愈出院。单心室矫治组19例患儿行Ⅱ期手术，包括1例内管道全腔静脉肺动脉吻合术，6例右侧Glenn术，5例右侧双向Glenn术，7例双侧双向Glenn术；延迟根治组10例患儿行Ⅱ期手术，包括5例右心室双出口矫正术及5例完全型心内膜垫缺损矫治术。结论PAB可有效限制肺血流，围术期配合靶向药物治疗可以辅助加强手术效果，为日后单心室修补及双心室修补赢得机会。Objective To observe the effect of pulmonary artery banding（PAB） on children with congenital heart disease complicated with pulmonary arterial hypertension （PAH） ; to investigate the effectiveness of pre-PAB use of cardiotonics and diuretics. Methods A total of 98 children with congenital heart disease and PAH who underwent PAB in Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University from August 2010 to March 2016 were retrospectively analyzed. According to the type of malformation, the children were divided into functional single ventricle repair group（n = 52 ） and delayed biventricular repair group （n = 46）. Systolic pulmonary artery pressure（sPAP） and oxygen saturation（ SpO2 ） were recorded. The operative effect was analyzed. Results Thirteen children（ 10 cases in functional single ventricle repair group and 3 cases in delayed biventricular repair group ） had cardiotonics and diuretics. In 98 children, postoperative sPAP and SpO2 significantly decreased compared to those before operationl functional single ventricle repair group： （28 ± 8）mmHg vs （59 ±20）mmHg, （79 26）% vs （90 ±6）% ; delayed biventricular repair group： （27 ± 11） mmHg vs （53 ± 14） mmHg, （88 ± 7） % vs （ 97 ± 4） % ] （ P 〈 0. 05 ）. There were 3 cases （ 3.1% ） of death ; 2 cases needed re-PAB to adjust the size of pulmonary artery band; 2 cases had hydropericardium after operation. Nineteen children in functional single ventricle repair group had second stage surgery, including 1 case of total cavopulmonary connection, 6 cases of right ventricular Glenn shunt, 5 cases of right ventricular bidirectional Glenn shunt and 7 cases of bilateral bidirectional Glenn shunt. Ten children in delayed biventricular repair group had second stage surgery, including 5 cases of double outlet right ventricle surgery and 5 cases of total endocardial cushion defect surgery. Conclusions PAB can effectively restrict pulmonary blood flow. Combined use of targeted

关 键 词：先天性心脏病 高血压 肺性 肺动脉环缩术 

分 类 号：R541[医药卫生—心血管疾病]