波生坦在围术期治疗先天性心脏病重度肺动脉高压的临床效果  

Clinical Observation of Bosentan in the Treatment of Congenital Heart Disease with Severe Pulmonary Arterial Hypertension during Perioperative Period

作　　者：杨旭[1] 马润伟[1] 宋怡[1] 张晓羽[1] 王霁阳[1] 张大勇 YANG Xu;MA Run-wei;SONG Yi;ZHANG Xiao-yu;Wang Ji-yang;ZHANG Da-yong(Department of Cardiovascular Surgery,The 2nd People's Hospital of Yunnan Province, Kunming Yunnan 650021,China)

机构地区：[1]云南省第二人民医院心血管外科,云南昆明650021

出　　处：《昆明医科大学学报》2017年第5期68-73,共6页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2014FZ045)

摘　　要：目的研究围手术期口服波生坦对先天性心脏病并重度肺动脉高压的治疗效果.方法 2012年6月至2016年6月在云南省第二人民医院心血管外科经右心导管检查证实平均肺动脉压(MPAP)50 mm Hg的48例先心病重度肺动脉高压患者纳入研究,平均(8.2±3.2)岁,其中单纯房间隔缺损(ASD)6例为ASD组,单纯室间隔缺损(VSD)16例为VSD组,房缺合并室缺12例为ASD+VSD组,动脉导管未闭(PDA)10例为PDA组,室缺合并动脉导管未闭4例为VSD+PDA组,所有患者术前2~3周开始口服波生坦,每日测量血压心率,所有患者服药2周后复查心脏彩超,测动脉血氧分压(Pa O2);14例临床症状较重者服药2周后行心导管复查,比较服药前后MPAP、肺血管阻力指数(PVRI)、平均动脉压(MAP)、MPAP/MAP及Pa O2变化;术后待循环稳定后继续用药,其中20例患者麻醉诱导后放置漂浮导管,比较这些患者术后服药后0.5 h、1 h、4 h、24 h的MPAP、MAP、MPAP/MAP、心脏指数(CI)、PVRI、体循环阻力指数(SVRI)变化趋势.结果 48例患者术前服药(13.53±3.45)d后复查心脏彩超,肺动脉收缩压(SPAP)较服药前明显下降,差异有统计学意义(P<0.05);各组口服波生坦后肺动脉收缩压(SPAP)、Pa O2与口服波生坦前相比差异均有统计学意义(P<0.05).14例临床症状较重者服药2周后行心导管复查Pa O2较口服波生坦前明显上升差异均有统计学意义(P<0.05);MPAP、PVRI、MPAP/MAP较口服波生坦前明显下降差异均有统计学意义(P<0.05);MAP与口服波生坦前比较差异无统计学意义(P>0.05).20例放置漂浮导管的患者,术后MPAP较术前差异有统计学意义(P<0.05),服药后0.5 h、1 h、4 h、24 h的MPAP较服药前明显下降,差异有统计学意义(P<0.05);MAP服药后0.5 h、1 h、4 h、24 h与服药前相比差异无统计学意义;MPAP/MAP服药后与服药前相比差异均有统计学意义(P<0.05);术后PVRI较术前差异有统计学意义(P<0.05),PVRI服药后0.5 h、1 h、4 h、24 h较服药�Objective To study the effects of oral bosentan for the treatment of severe pulmonary arterial hypertension(PAH)in patients with congenital heart disease during perioperative period.Methods From June2012to June2016,48patients(mean age of8.2±3.2years old)with congenital heart disease and severe PAHconfirmed by base line assessment of cardiac catheterization,and with mean pulmonary artery pressure(MPAP)≥50mmHg,were chosen for the study.Of all the cases,6were atrial septal defect(ASD)cases,16were ventricularseptal defect(VSD)cases,12were atrial septal defect(ASD)with ventricular septal defect(VSD)cases,10were patent ductus arteriossus(PDA)cases and4were ventricular septal defect(VSD)with patentductus arteriossus(PDA)cases.All patients took bosentan2to3weeks before surgery.Blood pressure and heartrate were measured daily.All patients were reviewed the cardiac color ultrasound and the arterial oxygen partial pressure(PaO2)for afer taking2weeks.14cases of severe clinical symptoms were reviewed the cardiac catheterizationafter taking2weeks,and changes in mean pulmonary artery pressure(MPAP),pulmonary vascular resistance index(PVRI),mean artery pressure(MAP),MPAP/MAP and arterial oxygen partial pressure(PaO2)were observedand compared.All the patients resumed medication,after circulatory stability was achieved.Then,20patientswere placed Swan-Ganz catheter following anesthesia.Changes in MPAP,MAP,MPAP/MAP,cardiac index(CI),PVRI and systemic vascular resistance index(SVRI)were observed and compared0.5h,1h,4hand24h after medication following anesthesia.Results For the48patients,who received medication for(13.53±3.45)days before surgery,cardiac color ultrasound in dicated that systolic pulmonary artery pressure(SPAP)was significantly lower than that before oral administration of bosentan,with statistical significance(P<0.05).There was significant difference in SPAP,PaO2before and after oral bosentan(P<0.05).14cases ofsevere clinical symptoms were reviewed the cardiac catheterization after taking2weeks,PaO2was significantl

关 键 词：波生坦 先天性心脏病 肺动脉高压 围手术期 

分 类 号：R654.2[医药卫生—外科学]