曲前列尼尔在成人先天性心脏病合并肺动脉高压围术期的疗效  

Efficacy of perioperative use of treprostinil in treating adult patients with congenital heart disease associated pulmonary arterial hypertension

作　　者：杨苾雯[1] 沈振亚[1] 胡雁秋[1] 余云生[1] 黄浩岳[1] YANG Biwen;SHEN Zhenya;HU Yanqiu(Department of Cardiovascular Surgery,First Affiliated Hospital,Soochow University,Suzhou 215000,CHINA)

机构地区：[1]苏州大学附属第一医院心血管外科,江苏215000

出　　处：《江苏医药》2021年第1期81-84,共4页Jiangsu Medical Journal

摘　　要：目的观察围术期应用曲前列尼尔对成人先天性心脏病合并中、重度肺动脉高压的疗效。方法成人先天性心脏病患者21例,术前心脏超声检查及右心导管造影确诊为中、重度肺动脉高压,均行一期心内畸形矫治术。所有患者术中放置Swan-Ganz导管。心肺转流停机前即开始持续泵入曲前列尼尔,记录用药前、用药后4 h、12 h、24 h及停药时的平均肺动脉压(MPAP)、MAP、MPAP/MAP、HR、肺毛细血管楔压(PCWP)、肺血管阻力(PVR)、CVP、心输出量(CO)和混合静脉血氧饱和度(SvO_(2))。结果患者开始输注曲前列尼尔后12 h、24 h和停药时的MPAP和PVR均较用药前下降,CO和SvO_(2)较用药前升高(P<0.05),而MAP无明显变化(P>0.05)。经过积极治疗,19例患者顺利拔除气管插管,2例术后因肺动脉高压危象无法脱机而行气管切开,并予增加曲前列尼尔使用剂量,而后顺利脱机。术后随访6个月,所有患者存活,无肺动脉高压反弹。结论围术期输注曲前列尼尔能有效降低成人先天性心脏病患者的MPAP和PVR,改善预后。Objective To observe the efficacy of perioperative use of treprostinil in the treatment of adult patients with congenital heart disease(CHD)associated moderate to severe pulmonary arterial hypertension(PAH).Methods The first-stage surgery for intracardiac malformation correction was performed in 21 adult patients with CHD associated with PAH confirmed by preoperative echocardiography and right cardiac catheterization.Swan-Ganz catheter was placed during operation and treprostinil was infused intravenously started before cardiopulmonary bypass(CPB).The relevant indicators were recorded including MPAP,MAP,PVR,HR,PCWP,CVP,CO MPAP/MAP,and SvO_(2) before(T0)and in the 4^(th)(T1),12^(th)(T2),and 24^(th) hour(T3)during and at the end of treprostinil infusion(T4).Results Compared to T0,MPAP and PVR were decreased,CO and SvO_(2) were increased significantly at T2,T3 and T4(P<0.05),while there were no significant changes in MAP(P>0.05).After active treatment,extubation was performed successfully in 19 patients.Tracheotomy was performed in 2 patients because of pulmonary hypertension crisis and difficult withdrawn of mechanical ventilation,who were out off mechanical ventilation after increasing dose of treprostinil.Six months follow-up showed that all patients were survived without PAH rebounding.Conclusion Perioperative infusion of treprostinil can effectively reduce MPAP and PVR and improve the prognosis in adult CHD patients with moderate to severe PAH.

关 键 词：曲前列尼尔 肺动脉高压 先天性心脏病 

分 类 号：R654[医药卫生—外科学]