论文部分内容阅读
目的 探讨幼婴先天性心脏病室间隔缺损 (VSD)合并肺动脉高压手术前、后肺动脉压力 (PAP)改变与预后的关系。方法 1994年 1月～ 1998年 12月我科施行幼婴VSD并中、重度肺动脉高压心内直视手术 70例 ,对比缺损修补前、后PAP改变 ,持续监测其中 35例术后PAP变化。结果 术前未作心导管检查者 ,术中测PAP可初步判断其肺高压程度。缺损修补后PAP较术前立即降低 40 %以上 ,说明肺动脉高压多为动力性 ,肺血管改变可逆 ,预后较好 ;如PAP较术前降低不足40 % ,对血管活性药物反应差者 ,预示肺血管病变较重 ,应警惕发生肺高压危象 ,考虑延长呼吸辅助及血管活性药物应用时间。术后 36～ 72h[(5 2 .33± 2 6 .88)h]是肺高压危象高发时段。结论 幼婴VSD合并中、重度肺动脉高压 ,其肺血管改变绝大多数属可逆性 ,持续监测PAP ,有助于及时发现肺高压危象 ,应用呼吸机辅助 ,使过度通气、镇静剂和血管活性药物 ,经肺动脉测压管滴注妥拉唑林是本组提高手术治愈率的有效措施。
Objective To investigate the relationship between the changes of pulmonary artery pressure (PAP) and the prognosis of infants with congenital heart disease and ventricular septal defect (VSD) before and after pulmonary hypertension. Methods From January 1994 to December 1998, 70 cases of infants with VSD and moderate and severe pulmonary hypertension underwent open heart surgery in our department. The PAP changes were compared before and after the defect repair, and the change of postoperative PAP was monitored in 35 cases. Results of cardiac catheterization was not preoperative, intraoperative PAP can be initially determine the degree of pulmonary hypertension. PAP after defect repair was reduced by more than 40% immediately before the operation, indicating that pulmonary hypertension is mostly dynamic, reversible pulmonary vascular changes, the prognosis is good; such as PAP decreased less than 40% preoperatively, poor response to vasoactive drugs, Vascular lesions heavier, should be alert to the occurrence of pulmonary hypertension crisis, consider extending the respiratory assistance and vasoactive drug application time. Postoperative 36 ~ 72h [(52.33 ± 26.88) h] is the period of high risk of pulmonary hypertension. Conclusions Infants and young children with moderate and severe pulmonary hypertension complicated by pulmonary hypertension often have reversible pulmonary vascular changes. Continuous monitoring of PAP helps to find out the risk of pulmonary hypertension in infants and young children. Using ventilator-assisted therapy, hyperventilation, sedation and vasoactive drugs , The pulmonary artery piezotomes instillation of lazoline forest is the group to improve the cure rate of effective measures.