单向活瓣补片在合并重度肺动脉高压先心病治疗中的应用  

One-way valved patch on congenital heart disease with severe pulmonary hypertention

作　　者：庞昕焱[1] 宋惠民[1] 苏润毅[1] 李守先[1] 毕研文[1] 李跃华[1] 

机构地区：[1]山东大学齐鲁医院,山东济南250012

出　　处：《山东医药》2002年第15期1-3,共3页Shandong Medical Journal

摘　　要：为探讨合并重度肺动脉高压先心病的有效治疗方法 ,采用单向活瓣补片对 30例本病患者进行手术治疗。术后 5例肺动脉压力下降明显 ,未出现跨单向活瓣补片分流 ;余 2 5例 72小时内出现分流 ,其中 1例术后 72小时死于低心排综合征 ,1例 4周死于右心衰竭 ;2 8例康复出院。对术后出现分流的 2 0例随访 3～ 4 1个月 ,其中术后 3个月仍出现跨单向活瓣补片分流 6例 ,右向左分流 3例 ,双向分流 3例 ;半年以上仍存在单向活瓣补片分流 4例 ,其中 3例肺动脉收缩压 (PP) /主动脉收缩压 (PS) >0 .75 ,2例右向左分流 ,1例双向分流 ;另 1例 PP/ PS降至 0 .4 5 ,存在 3mm跨单向活瓣补片左向右分流。 18例自觉症状及生活质量较术前改善明显。表明对于合并重度肺动脉高压的先心病应用单向活瓣补片行手术修补 ,允许右向左、阻止左向右分流 ,术后右心压力高于左心者右心血流可通过单向活瓣补片活瓣孔分流到左心系统 ,为右心起到泄洪减压作用 ,同时以可以耐受的体循环血氧饱和度降低为代价增加左心系血容量 ,保证左心排出量 ,有利于保持体肺循环相对平衡 ,使患者度过术后危险期 。The one way valved patch was used in 30 patients of congenital heart disease with severe pulmonary hypertention(PP/PS>0 75)in operation It can minize the risk of postoperative right heart failure and increase left cardiac output,at the expense of systemic low oxygen saturation,however well tolerated Trans patch shunt was determained in 25 cases within postperative 72 hours With 2 postoperative death,1 died of low cardiac output syndrom 72 hours after operation,and the other died of right heart failure 4 weeks after operation 3 months follow up showed trans patch shunt in 6 cases,right to left shunt in 3 cases and two side shunt in other 3 cases Colour doppler ultrasonography examination proved trans patch shunt in 4 cases 6 months after operation,right to left shunt in 1 case,two side shunt in 2 casas,and leftto right shunt in 1 case(PP/PS=0 45) It suggests that the one way valved patch is useful in operation of selected patients in which postoperative right heart faulure can be anticipated

关 键 词：单向活瓣补片 先天性心脏病 间隔缺损 肺动脉高压 手术治疗 

分 类 号：R541.1[医药卫生—心血管疾病] R654.2[医药卫生—内科学]