肺动脉压监测在幼婴室间隔缺损并中、重度肺高压修补术中的意义探讨

Study of continuous pulmonary artery pressure monitor in ventricular septal defect associated pulmonary hypertension in infants

目的 探讨幼婴先天性心脏病室间隔缺损 (VSD)合并肺动脉高压手术前、后肺动脉压力 (PAP)改变与预后的关系。方法 1994年 1月～ 1998年 12月我科施行幼婴VSD并中、重度肺动脉高压心内直视手术 70例 ,对比缺损修补前、后PAP改变 ,持续监测其中 35例术后PAP变化。结果 术前未作心导管检查者 ,术中测PAP可初步判断其肺高压程度。缺损修补后PAP较术前立即降低 40 %以上 ,说明肺动脉高压多为动力性 ,肺血管改变可逆 ,预后较好 ;如PAP较术前降低不足40 % ,对血管活性药物反应差者 ,预示肺血管病变较重 ,应警惕发生肺高压危象 ,考虑延长呼吸辅助及血管活性药物应用时间。术后 36～ 72h[(5 2 .33± 2 6 .88)h]是肺高压危象高发时段。结论 幼婴VSD合并中、重度肺动脉高压 ,其肺血管改变绝大多数属可逆性 ,持续监测PAP ,有助于及时发现肺高压危象 ,应用呼吸机辅助 ,使过度通气、镇静剂和血管活性药物 ,经肺动脉测压管滴注妥拉唑林是本组提高手术治愈率的有效措施。

Objective To investigate the pre and postoperative changs of pulmonary artery pressure (PAP) of ventricular septal defect ( VSD ) associated pulmonary hypertension (PH) in infancy. Methods Seventy infants of VSD with moderate to severe PH underwent open heart surgery from Jan.1994 to Dec. 1998. A comparison between the changes of pre and postoperative PAP was observed on 35 cases by continuous pulmonary pressure monitoring. Results The study demonstrated the degree of VSD associated pulmonary hypertension. After reparation PAP decreasing more than 40% predicted a reversible pulmonary vascular change otherwise it should be cautious of an irreversible pulmonary vascular variation and postopertive pulmonary hypertension crisis (PHC). The PHC was happened 36～72 hours ( mean= 52.33 ± 26.88 ) postoperatively in our series. Conclusions Most of the pulmonary vessel changes in infancy of VSD with moderate to severe PH are reversible. Continuous monitoring of PAP is useful in early diagnosing and managing the PHC . Using of inotropic agents, Tolazoline infusion via PA catheter and appropriate overhyperventilation are important to increase the operative successful rates.