风心病二尖瓣狭窄合并肺动脉高压围术期血流动力学的变化

Perioperative hemodynamic changes in mitral stenosis with pulmonary artery hypertension

目的:观察风湿性心脏病(风心病)二尖瓣狭窄肺动脉高压围术期的转归规律。方法:风心病二尖瓣狭窄合并肺动脉高压患者37例(男11,女26),以平均肺动脉压5.33kPa为界分肺动脉高压(PH)组和严重肺动脉高压(SPH)组。应用Swan-Ganz导管和HP监护系统测定围术期血流动力学的变化。结果:PH组术后即刻及术后48h心排血指数(CI)有明显增加,平均肺动脉压(PAPm)、肺血管阻力指数(PVRI)、肺动脉楔压(PAWP)均有明显下降;SPH组有与PH组相似的变化趋势,但程度小于PH组。结论:风心病二尖瓣狭窄合并肺动脉高压患者二尖瓣置换术后早期肺血流动力学即有明显的改善。

Objective: To study the rule of perioperative hemodynamic changes in mitral stenosis with pulmonary artery hypertension. Methods: Thirty seven patients with mitral stenosis and secondary pulmonary artery hypertension were divided according to the absence or presence of severe preoperative pulmonary artery hypertension, defined as a mean pulmonary artery pressure ≥5.33 kPa. Perioperative hemodynamic data were obtained wigh Swan Ganz catheter and the HP compact configurable monitors. Results: In pulmonary artery hypertension group and severe pulmonary artery hypertension group, PAPm, PVRI and PAWP were reduced significantly, and CI increased significantly, but in severe pulmonary artery hypertension group, PAPm, PVRI and PAWP were still in a high level. Conclusion: The patient with mitral stenosis and pulmonary artery hypertension have a good result immediately after mitral valve replacement.