室间隔缺损术后反应性肺高压危险因素及疗效分析

The risk factors and management for reactive pulmonary hypertension after corrective surgery of ventricular septal defect

目的探求室是隔缺损、肺高压患儿术后反应性肺高压的发生率、危险因素。评估术后反应性肺高压的治疗效果。方法对1991年至2006期间术前诊断室间隔缺损、肺高压在我科接受室间隔缺损修补术患儿的客观病史资料进行回顾性研究。搜集患儿围术期客观指标进行统计和分析，评估术后早期疗效。探求术后反应性肺高压的危险因素。结果16年间共2141例室间隔缺损合并肺高压的患儿纳入本课题。术后住院早期死亡20例，住院晚期死亡3例，术后病情平稳出院2118例。术后反应性肺高压发生率为6．1％，术后肺高压危象的发生率为2．1％、死亡率为2．3％。术中体外循环时间≥90min（P〈0．01）、主动脉阻断时间≥75min（P％0．01）、术后残余分流（P〈0．01）是发生术后反应性肺高压的相关危险因素。结论室间隔缺损、肺高压的患儿术后反应性肺高压的独立危险因素有：术前年龄、Pp／Ps、存在充血性心力衰竭、术后二尖瓣反流中度以上。术后反应性肺高压的患儿更容易依赖儿茶酚胺类药物，左房途径输入儿茶酚胺类药物能增加其强心效果。

Objective To study the risk factors and management for reactive pulmonary hypertension （RPH） after corrective surgery of ventricular septal defect （VSD） in children. Methods From 1991 to 2006, 2141 patients who underwent corrective surgery for VSD were recruited in this study. The patients＂ clinical data, including patients＂ gender, age, diagnosis, the ratio of pulmonary pressure to systolic pressure （Pp/Ps）, the time of cardiopulmonary bypass （CPB）, postoperative RPH, pul- monary hypertension crisis （PHC） and other complications, and the treatment of RPH, were retro- spectively analyzed. The risk factors of postoperative RPH were statistically analyzed. The outcomes of RPH treatment were also evaluated. Results Twenty patients died during the early in-hospital period, 3 patients died during the late in-hospital period, and the others were recovered after surgery. The mobility of postoperative RPH and PHC were 6. 12% and 2. 06%, respectively. The overall mortality of the patients was 2. 27%. The patients had CPB≥90 rain, aortic clamp time≥75 min, postoperative catecholamines treatment, and residual intracardiac shunting after surgery were more likely to develop postoperative RPH. Conclusions The independent risk factors of postoperative RPH include patients＂ Pp/Ps ratio, age, congestive heart failure before surgery, moderate mitral regurgitation after surgery. Catecholamines treatment could effectively improve right ventricular function in the patients with RPH.