前列腺素E_1在婴儿室间隔缺损并肺高压的应用

Application of prostaglandin E_1 to ventricular septal defect and pulmonary hypertension in infants

目的 探讨术前应用前列腺素E1(PGE1)对室间隔缺损并肺高压婴儿 ,增强心功能 ,降低肺动脉及肺小动脉阻力 ,提高手术耐受性的意义。方法 本组 18例 ,男 13例 ,女 5例。年龄 5个月～ 6岁平均 (2 9.6 7± 2 3.14 )个月。术前经右心导管测量右房、肺动脉、肺小动脉压力及相应部位的血氧含量 ,依Fick’s公式分别计算出体循环、肺循环血流量及分流量 ,肺小动脉阻力、肺总阻力。选取Pp/Ps>0 .4 5者为研究对象。术前给予静滴PGE114d ,观察患儿用药后气急、肺部叮罗音的改变。对比根治手术中所测量肺动脉及肺小动脉压力 ,再次计算出上述各项数据。结果 用药后肺动脉压、肺小动脉压、Pp/Ps、全肺阻力、肺小动脉阻力等均有明显下降 ;在心内分流量及体循环压力基本不变情况下 ,左、右心排量明显增加。全组病例术后均治愈。随访 2年患儿生长发育良好。结论 PGE1是一种强有力的血管扩张剂 ,能直接扩张肺动脉 ,降低肺动脉、肺小动脉压力和肺循环阻力 ,提高左右心输出量 ,改善心功能。术前用药可改善患儿心肺功能 ,增加对体外循环及手术的耐受性 。

Objective To study the selective action of prostaglandin E 1 (PGE 1) on reducing resistance of pulmonary artery and arterioles in ventricular septal defect with pulmonary hypertension in infants. Methods Eighteen infants (male 13, female 5) suffering from ventricular septal defect with pulmonary hypertension were evaluated. Their age ranged from 5 months to 6 years (mean, 29.67 ± 23.14 mon).The hemodynamics and cardiac output were measured via right cardiac catheterization. The Pp/Ps ratio in this group was more than 0.45 . All cases were administered PGE1 by intravenous pump with a dose of 50～ 100?ng/kg ·min for two weeks preoperatively. The same measurements were repeated during open heart operation before the bypass. Results Compared with the measurements before the use of PG E 1, there was an obvious decrease in pulmonary artery pressure, pulmonary capillary wedge pressure, total pulmonary vascular resistance and pulmonary capillary resistance. However, the cardiac output was markedly increased from 2.58 ± 0.58 to 3.87 ± 1.03 ?L/min ( P < 0.001 ). No significant change was found in both the systemic pressure and Qp/Qs ratio ( P > 0.05 ). The follow up results of all subjects for a period of two years were satisfactory. Conclusions PGE 1 has the selective action on pulmonary vasodilatation . It effectively reduces pulmonary arterial pressure and capillary wedge pressure, total pulmonary vascular and arterial resistance, and increases cardiac output simultaneously. The present study showed that the administration of PGE1 before operation could improve cardiac function and reduce postoperative pulmonary hypertension crisis without major adverse reaction in infants with VSD and pulmonary hypertension.