先天性心脏病伴重度肺动脉高压术后肺高压危象的监控与预防

Monitoring and Prevention of Postoperative Pulmonary Hypertensive Crisis in Patients with Congenital Heart Defects Associated with Severe Pulmonary Arterial Hypertension

目的探讨先天性心脏病（先心病）伴肺动脉高压术后肺高压危象的监控及预防。方法回顾性分析1995—2006年监护治疗的113例先心病伴重度肺高压和51例先心病伴中度肺高压病人中术后肺高压危象的发生率，分析肺高压危象与术时肺高压程度、术后肺动脉压下降程度、手术的年龄及术后预防措施的关系。结果113例重度肺高压病人中发生肺动脉高压危象18例（15．9％）；51例中度肺高压患者中无肺高压危象发生。术毕Pp/Ps〈0．5者肺高压危象发生率为7．2％，Pp／Ps≥0．5者肺高压危象发生率为40．0％。术时年龄1-3岁组术后易发生肺高压危象。〈1岁组发生率5．4％，1-3岁组发生率为25．9％，≥3岁组发生率为5．6％。采取系列预防措施后发生率由22．4％下降至6．5％。结论对有发生肺高压危象倾向者，采取严密的监控及个体化施药。早期治疗是预防术后肺高压危象的重要措施。

Objective To explore the management of monitoring and preventiou of postoperative pulmonary hypertensive crisis in patients with congenital heart defects （CHD） associated with severe pulmonary arterial hypertension （PAIl）. MetieRs 113 patients with CHD-assodated severe PHA and 51 cases of CHD with moderate PAIl which were enrolled to be treated in intensive care unit （ICU） postoperatively between 1995 and 2006. A retrospective analysis was used to analyze the morbidity of postoperative pulmonary hypertensive crisis in two groups and the relationship of postoperative pulmonary hypertensive crisis with preoperative and postoperative pulmonary arterial pressure, timing of operation and a series of postoperative prevention management. Results Ofthell3severePAHpatients, pulmenary hypertensive crisis ocmLmxt in 18cases （15.9%o）, and no pulmonary hypertensive crisis ~mLmxt in 51 moderate PAH patients. The ratio of postoperative pulmonary hypertensive crisis was 6/83 （7.2%） in patients whose postoperative Pp/Ps 〈0. 5, and 12/30 （40.0%） in those postoperative Pp/Ps 90.5. Postoperative pulmonary hypertensive crisis （25.86%） was easy to occur in group whose age from 1 to 3 years. The ratio of postoparative pulmonary hypertensive crisis was 5.4% in those aged younger 1 year, 25.9% in those aged from 1 to 3 years and 5.6% in those aged over 3 years. The morbidity of postoperative pulmonary hypertensive crisis was decreased from 22.4% to 6.5% in patients after adopted a series of preventive management. Conclusion Postoperative pulmonary arterial monitoring and individual vasedilator administratiou should be carried out in patients who have a significant risk of pulmonary hypertensive crisis. Early surgical treatment is an inerrant way to prevent postoperative pulmonary hypertensive crisis.