婴幼儿室间隔缺损合并肺动脉高压体外循环后应用磷酸肌酸钠的效果观察

Efficacy of creatine phosphate in infants with ventricular septal defect combining pulmonary hypertension after cardiopulmonary bypass

目的探讨磷酸肌酸钠在婴幼儿室间隔缺损（VSD）合并肺动脉高压（PH）体外循环（CPB）术后对患儿血流动力学及心功能的影响。方法选择2011年10月～2012年12月确诊为VSD合并PH，体外循环下行心脏直视手术的患儿105例，将其分为两组。对照组40例．体外循环术后常规给予呼吸机支持、强心利尿、血管活性药物等；治疗组65例，体外循环术后除常规给予上述治疗外，给予注射用磷酸肌酸钠2．0g，静脉滴注5d。结果两组术前心率（HR）、桡动脉收缩压（SAP）、中心静脉压（CVP）、左心室射血分数（EF）、左心室长轴缩短率（FS）、肺动脉压力（PAP）及氧分压（PO2）比较差异无统计学意义（P〉0．05）。体外循环术后5d，治疗组患儿HR为（110±11）次／min，与对照组患儿[（120±13）次/min]比较，降低明显，差异有统计学意义（P〈0．05）；治疗组患儿SAP为（107±18）mm Hg，与对照组患）L[（91±23）mmHg]比较，升高明显，差异有统计学意义（P〈0．05）；治疗组患儿EF为（58±6）％，与对照组患儿[（53±11）％]比较，升高明显，差异有统计学意义（P〈0．05）；治疗组患儿PAP为（49±13）mmHg，与对照组患）L[（60±15）mmHg]比较，降低明显，差异有统计学意义（P〈0．05）。治疗组较对照组患儿血流动力学及心脏功能改善明显。两组术后呼吸机时间及监护室（ICU）滞留时问差异有高度统计学意义[（38±12）h比（55±13）h；（121±44）h比（188±61）h1（P〈0．01）。结论婴幼儿VSD合并PH体外循环术后应用磷酸肌酸钠可以明显改善患儿术后的血流动力学及心功能，明显缩短术后ICU滞留时间。

Objective To investigate the effect of creatine phosphate sodium （CP） in infants with ventricular septal de- fect （VSD） combining pulmonary hypertension （PH） on the hemodynamics and cardiac function in infants after ear- diopulmonary bypass （CPB）. Methods 105 cases of children diagnosed as VSD combining PH performing open heart surgery on extracorporeal circulation from October 2011 to December 2012 were selected. After cardiopulmonary by- pass, 40 cases in the control group were given ventilator support, cardiotonic, diuretic and vasoactive drugs; after car- diopulmonary bypass, 65 cases in the treatment group were given CP 2.0 g injection, intravenous drip for 5 days, in ad- dition to the above conventional treatment. Results The heart rate （HR）, radial artery systolic pressure （SAP）, central venous pressure （CVP）, left ventrieular ejection fraction （EF）, left ventricular long axis shortening （FS）, pulmonary artery pressure （PAP） and partial pressure of oxygen （PO2） were not significantly different （P 〉 0.05） in the two groups before operation. After cardiopulmonary bypass 5 d, the treatment group HR was （110±11） times/rain, and the control group was （120±13） times/min, which was decreased with a statistically significant difference （P 〈 0.05）; the treatment group was SAP （107±18） mm Hg, and the control group was （91±23） mm Hg, which was increased, with a statistically significant difference （P 〈 0.05）; the treatment group EF was （58±6）%, and patients in the control group was （53±11）%, which was increased with a statistically significant difference （P 〈 0.05）; the PAP of treatment group was （49±13） mm Hg, and the control group was （60±15） mm Hg, which was decreased obviously, there was a statistically significant differ- ence （P 〈 0.05）. The hemodynamics and heart function in the treatment group was improved significantly than the con- trol group. The using respirator time and ICU time of the two groups were significantly different [（38±12） h vs （55±13） h; （121±44） h vs （188±61） h] （P 〈 0.01）. Conclusion CP can significantly improve the hemodynamics and cardiac func- tion, shorten the times of using respirator and ICU in the infants with ventricular septal defect and pulmonary hyperten- sion after cardiopulmonary bypass.