双心房输注在并发肺动脉高压的复杂性先天性心脏病患儿手术中的应用评价

Effects of biatrial infusion on intraoperative hemodynamics after cardiopulmonary bypass in patients undergoing correction of complex congenital heart disease

目的：评估双心房输注对并发肺动脉高压的复杂性先天性心脏病患儿（复杂先心病）术后血流动力学的影响。方法：择期行复杂先心病矫治术的患儿46例，年龄6月一5岁，体质量5～19kg，心功能分级Ⅱ或Ⅲ级，随机分为两组（每组n=23）：双心房输注组（经左房泵入具有血管收缩作用的正性肌力药，从右房或肺动脉泵入血管扩张药物）和右心房输注组（直接经右房泵入具有血管收缩作用的正性肌力药和血管扩张药物）。腔静脉开放后常规给予血管活性药物，双心房输注组经中心静脉输注米力农0．5～0．75μg／（kg·min），经左心房输注多巴胺5～lOμg/（kg·min）、肾上腺素0．03～0．1μg／（kg·min）。右心房输注组经中心静脉输注米力农0．5-0．75μg／（kg·rain）、多巴胺5-10μg/（kg·min）、肾上腺素0．03～0．1μg／（kg·min）。分别于给药前5min（TO）、给药后5min（T1）、10min（T2）、30rain（耶）和60min（T4）时记录平均动脉压（MAP）、HR、平均肺动脉压（MPAP）、左心房压（LAP）、中心静脉压（CVP）和心排出量（CO），计算肺血管阻力指数（PVRI）、体循环血管阻力指数（SVRI）和心指数（cI）。结果：与11D时比较，双心房输注组T1一T4时MAP、CI和SVRI升高，HR、MPAP、T｜AP、CVP和PVRI降低（均P〈0．05）；右心房输注组T1～T4时MAP、MPAP、LAP和PVRI降低，cI升高（均P〈0．05），HR、CVP和SVRI差异无统计学意义。与右心房输注组比较，双心房输注组MAP、CI和SVRI升高，HR、MPAP、LAP、PVRI和CVP降低（均P〈0．05）。结论：双心房输注可改善复杂先心病患者矫治术后左心排血功能，降低肺动脉压和肺循环血管阻力。

AIM： To investigate the effects of biatrial infusion on the intraoperative hemodynamics after cardiopulmonary bypass （CPB） in patients undergoing correction of complex congenital heart disease complicated by pulmonary hypertension （PH）. METHODS： Forty-six NYHA class II or Ill patients （aged 6 months to 5 years and weighing 5 - 19 kg） undergoing corrective surgery for complex congenital heart disease complicated by PH were randomly divided into two groups （ n -- 23 each）. Group I was the double atrial infusion group in which drugs with vasoconstrictive and positive inotropic effect were pumped via the left atrium and drugs with vasodilative effect were pumped via the right atrium or pulmonary artery. Group II was the right atrial infusion group in which vasoconstrictive and positive inotropic drugs and vasodilative drugs were pumped directly via the right atrium. MAP, HR, MPAP, PCWP, CVP and CO were recorded 5 rain before drug administration （T0） as well as 5, 10, 30 and 60 rain after drug administration （T1 -4 ）. Pulmonary vascular resistance index （PVRI）, systemic vascular resistance index （SVRI） and CI were also calculated. RESULTS： Compared with those at TO, MAP, MPAP, PCWP and PVRI significantly decreased, whereas CI increased at T1 -4 in group II and MAP, CI and SVRI significantly increased. HR, MPAP, PCWP, CVP and PVRI decreased at T1 -4 in group II （P 〈 0.05）. Compared with those in group II, MAP, CI and SVRI were significantly higher and HR, MPAP, PCWP, PVRI and CVP were lower （P 〈 0. 05 ）. CONCLUSION： Biatrial infusion can effectively reduce PAP and PVRI and increase CI after CPB during correction of complex congenital heart disease complicated by PH.