先天性心脏病合并重度肺动脉高压的外科治疗

Surgical treatment of congenital heart disease with severe pulmonary hypertension

目的探讨先天性心脏病合并重度肺动脉高压外科治疗经验。方法2002年9月至2007年9月共手术治疗先天性心脏病合并重度肺动脉高压患者79例,围术期采用综合性降肺动脉压措施,注意保护心肺功能,术后合理使用呼吸机及前列腺素E1,保持呼吸道通畅。结果早期死亡6例(7.59%),术后出现肺动脉高压危象8例(10.12%)。随访62例,所有肺动脉高压均降至中度以下。结论术前准确判断肺动脉高压性质并行降肺动脉压治疗、围术期注意维护心肺功能,合理应用肺血管扩张药物,有利于降低死亡率,减少并发症。

Objective To explore surgical treatment of congenital heart disease （CHD） in patients with severe pulmonary hypertension（PH）. MEthods From September 2002 to September 2007, a total of 79 patients of CHD with severe PH were underwent open - heart surgery. During perioperation, comprehensive managements were taken to drop pulmonary artery pressure and to protect cardiorespiratory function. After operation, the ventilator and prostaglandin E1 were used rationally in order to maintain the patency of airway. Results Six cases died （ 7.59% ） early postoperation and 8 cases （ 10.12% ） discovered from postoperative crisis of PH. The other 62 patients were followed up for 6 months to 5 years with good recovery and puhnonary artery pressure dropped to moderate level. Conclusion Preoperative accurate recognition of the characteristics of PH, perioperative maintenance of cardiorespiratory function and reasonable administration of the drugs for expansion of pulmonary vascular are the vital points to improve the survival of CHD patients with PH and reduce complications.