室间隔缺损合并重度肺动脉高压的诊断性治疗及远期随访

The application of diagnostic treatment in ventricular septal defects patients associated with severe pulmonary arterial hypertension and long-term effects

目的:分析室间隔缺损合并重度肺动脉高压(pulmonary hypertension,PH)患者的诊断性治疗及远期随访结果,总结先天性心脏病(先心病)合并重度肺动脉高压患者的诊断性治疗体会。方法:2005年10月至2010年12月,收治室间隔缺损合并重度肺动脉高压患者65例,分别给与选择性扩张肺动脉药物治疗,以不吸氧状态下末梢氧饱和度稳定在95%以上为主要标准,判断手术指征。结果:手术54例,均在体外循环下行室间隔缺损修补术。围手术期死亡1例,无远期死亡,11例不具备手术条件,继续药物治疗。随访12～36个月,平均肺动脉压力低于40 mmHg(1 mmHg=0.133 kPa)。未手术患者肺动脉压力明显降低,心功能明显改善。结论:通过药物对重度肺动脉高压患者进行诊断性治疗,可以对肺动脉高压性质做出准确的判断,能获得良好的疗效。

Objective：To evaluate the standard of operative indications and the perioperative manage- ment of ventricular septal defect complicated with severe pulmonary hypertension. Methods： From October 2005 to December 2010, 65 patients suffered ventricular septal defect accompanying with severe pulmonary hy- pertension were given selective dilation of the pulmonary vasodilator drugs. Standard of operative indications was on the base of change of SpO2, echocardiogram and X-ray. Results ： After the pre-operation preparative, 54 ca- ses operation was performed, 1 patient died in hospital. The follow-up showed that the pulmonary pressure was significantly decreased. Conclusion： Satisfactory result can be achieved in treatment of ventricular septal defect complicated with severe pulmonary hypertension by comprehensive preoperative management and preoperative a- nalysis of surgical indications.