成人紫绀型法洛四联症患者合并高血压的临床分析

CLINICAL ANALYSIS OF TETRALOGY OF FALLOT WITH HYPERTENSION IN ADULT

本文总结 10 9例四联症合并高血压患者的临床资料 ,重点观察临床表现并探讨临床意义。其主要临床特点是 :①血压虽高 ,但缺乏高血压症状 ;②四联症患者常见的蹲踞、缺氧表现较儿童四联症患者显著减少 ;③尿化验有改变的发生率高 (6 9 7% ) ;④右心负荷较一般成人四联症明显增重。通过 2例降压治疗一周诱发严重缺氧发作的教训和所有心内修复术后血压及尿改变恢复正常的经验 ,认识这种特殊表现的意义是 :①这种高血压是继发性高血压 ,成人四联症比较常见 (2 3 7% ) ;②高血压具有减少右向左分流、增加肺血流的保护作用 ,不适当降压可诱发严重缺氧 ;③为防脑卒中 ,造影时用硝普钠缓慢静点 ,在体循环压逐渐下降而不低于右室收缩压时造影比较安全 ;④心内修复术后尿改变恢复正常 。

This study summarized the clinical data of 109 cases of tetralogy of Fallot with hypertension in adult for investigating its clinical features and significance. The clinical features showed:①The blood pressure of patients is higher but manifesting no symptoms of hypertension; ②The most common features of squatting and hypoxic spell are less common seen in adults than in children;③69.7% of adults with tetralogy of Fallot show changes in urinary examinations; ④Right hearty load is higher in adults patients. In 2 patients serious hypoxic spell occurred after 1 week of therapy to lower blood pressure, and the blood pressure and urinalysis became normal after operation in all the patients. The experiences were: ①Secondary hypertension occurs in 23.7% of cyanotic adults; ②It is best to avoid treatment for lowing blood pressure, because hypertension trends to decreased right to left intracardiac shunt and increase pulmonary blood flow to alleviate server hypoxic spell; ③To prevent cerebrovascular accident during angiocardiography, it is advised to give sodium nitroprusside in slow intravenous dripping, so as to lower systemic blood pressure to a level which is higher than the systolic pressure of right ventricle; ④The blood pressure and urinalysis become normal after the operation, indicating that hypoxic damages to the kidney is reversible.