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 combined with pulmonary hypertention

目的探讨先天性心脏病合并重度肺动脉高压的外科治疗经验。方法34例患者均在体外循环下手术治疗,均采用胸部正中切口。房间隔缺损(直径>1.5cm)、室间隔缺损(直径>1.0cm)均采用涤纶片修补;动脉导管未闭在并行循环下切开肺动脉,于导管置入Foley氏尿管注水暂时堵住血流,采用涤纶片修补或双头针褥式缝合。术前给予吸氧、高压氧及前列腺素E1等治疗,术中应用抑肤酶及低温肺保护液肺动脉灌注等手段。结果32例手术顺利,术后肺动脉压下降3.2～5.5kPa。2例术后早期死于不可复性心功能衰竭。死亡率5.9%。结论正确掌握手术适应证,术中减少心肌及肺血管损伤,充分的围术期处理是手术成功的关键。

Objective To explore the surgical treatment of congenital heart disease combined with severe pulmonary hypertension. Methods 34 patients received surgical repairs under cardiopulmonary bypass （CPB）. Mid-sternal thoracotomy was performed in all cases. Atrial septal defect（ASD）,more than a diameter of 1. 5 cm） and ventricular septal defect（VSD,more than a diameter of 1. 0 cm） were repaired with dacron patch. With the arterial duct being patent and through the pulmonrary incision under parallel CBP,the blood flow was temporarily blocked by a Foley＇s urinary catheter with water-infused balloon and the Dacron patch repair or mattress suture with double ended needle was made in operation. All patients were treated pre-operatively with oxygen inhalation therapy,hyperbaric oxygenation,prostaglandin E1 respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass,pulmonary artery perfusion was performed with protective solution containing aprotinin for lung protection. Vasoactive drugs were routinely administrated postoperatively. Results 32 cases underwent the surgical treatment successfully with their postoperative pulmonary artery pressure decreased by 3. 2 ～ 5. 5kPa and 2 cases died of heart failure. The mortality was 5. 9%. Conclusion The key to this kind of surgical treatment is to define the surgical indications correctly,to reduce the intraoperative myocardial and pulmonary vascular injuries and to take good measures in perioperative treatment.