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目的:评估双心房输注对并发肺动脉高压的复杂性先天性心脏病患儿(复杂先心病)术后血流动力学的影响。方法:择期行复杂先心病矫治术的患儿46例,年龄6月~5岁,体质量5~19 kg,心功能分级Ⅱ或Ⅲ级,随机分为两组(每组n=23):双心房输注组(经左房泵入具有血管收缩作用的正性肌力药,从右房或肺动脉泵入血管扩张药物)和右心房输注组(直接经右房泵入具有血管收缩作用的正性肌力药和血管扩张药物)。腔静脉开放后常规给予血管活性药物,双心房输注组经中心静脉输注米力农0.5~0.75μg/(kg·min),经左心房输注多巴胺5~10μg/(kg·min)、肾上腺素0.03~0.1μg/(kg·min)。右心房输注组经中心静脉输注米力农0.5~0.75μg/(kg·min)、多巴胺5~10μg/(kg·min)、肾上腺素0.03~0.1μg/(kg·min)。分别于给药前5 min(T0)、给药后5 min(T1)、10min(T2)、30 min(T3)和60 min(T4)时记录平均动脉压(MAP)、HR、平均肺动脉压(MPAP)、左心房压(LAP)、中心静脉压(CVP)和心排出量(CO),计算肺血管阻力指数(PVRI)、体循环血管阻力指数(SVRI)和心指数(CI)。结果:与T0时比较,双心房输注组T1~T4时MAP、CI和SVRI升高,HR、MPAP、LAP、CVP和PVRI降低(均P<0.05);右心房输注组T1~T4时MAP、MPAP、LAP和PVRI降低,CI升高(均P<0.05),HR、CVP和SVRI差异无统计学意义。与右心房输注组比较,双心房输注组MAP、CI和SVRI升高,HR、MPAP、LAP、PVRI和CVP降低(均P<0.05)。结论:双心房输注可改善复杂先心病患者矫治术后左心排血功能,降低肺动脉压和肺循环血管阻力。
PURPOSE: To evaluate the effect of biliary infusion on postoperative hemodynamics in children with complex congenital heart disease complicated with pulmonary hypertension. Methods: Forty-six children with complicated congenital heart disease undergoing elective surgery were randomly divided into two groups (n = 23 each): 46 children aged 6 months to 5 years, body weight 5 to 19 kg and heart function class Ⅱ or Ⅲ. A double atrial infusion group (by pumping into the left atrium with vasoconstriction of inotropic drugs, from the right atrium or pulmonary artery to pump vasodilator drugs) and right atrial infusion group (directly through the right atrium into the vasoconstriction Of inotropes and vasodilators). Vasoactive drugs were given routinely after the opening of the vena cava. The bilateral atrial infusion group was infused with 0.5 ~ 0.75 μg / (kg · min) of milrinone via central venous infusion and 5 ~ 10 μg / (kg · min) Epinephrine 0.03 ~ 0.1μg / (kg · min). The right atrium was infused with 0.5 ~ 0.75μg / (kg · min) milrinone, 5 ~ 10μg / (kg · min) dopamine and 0.03 ~ 0.1μg / (kg · min) epinephrine via the central venous infusion group. Mean arterial pressure (MAP), HR, mean pulmonary arterial pressure (MAP) were recorded at 5 min (T0), 5 min (T1), 10 min (T2), 30 min (T3) and 60 min (T4) (MPAP), left atrial pressure (LAP), central venous pressure (CVP) and cardiac output (CO) were measured. Pulmonary vascular resistance index (PVRI), systemic vascular resistance index (SVRI) and cardiac index (CI) were calculated. Results: Compared with T0, MAP, CI and SVRI increased, HR, MPAP, LAP, CVP and PVRI decreased in both groups (all P <0.05) MAP, MPAP, LAP and PVRI decreased, CI increased (all P <0.05), HR, CVP and SVRI had no statistical significance. Compared with the right atrium infusion group, MAP, CI and SVRI increased, HR, MPAP, LAP, PVRI and CVP decreased in both atrial infusion groups (all P <0.05). Conclusion: Bipolar infusion can improve left ventricular ejection function, reduce pulmonary arterial pressure and pulmonary vascular resistance in patients with complicated congenital heart disease.