高原地区室间隔缺损合并肺动脉高压手术治疗的早期疗效

Surgical treatment for ventricular septal defect complicated with pulmonary hypertension at high altitude

目的：评价高原地区室间隔缺损（VSD）合并肺动脉高压手术治疗的早期疗效。方法：回顾性分析2001年6月至10月在海拔 3 700 m手术治疗的VSD合并肺动脉高压患者18例。其中藏族10例，世居西藏地区的汉族 8例；合并继发孔型房间隔缺损（ASD）4例、动脉导管未闭（PDA）4例、中度以上三尖瓣功能性关闭不全7例。术前动脉血氧分压50．1～61．4mmHg（1mmHg=0．133 kPa）、碱剩余-11．0～４．3。均在浅低温、中度血液稀释体外循环下施行手术，其中采用心脏不停跳方法 10例。VSD直接缝合10例，补片修补8例，同期行 PDA结扎4例，ASD修补4例，改良De Vega三尖瓣成形术7例。结果：无手术死亡；除1例术后早期出现肺动脉高压危象外，其余患者的肺动脉压在术后12h后均有不同程度的下降；均未出现其他严重的心、肺并发症；术后均痊愈出院，出院时经超声心动图检查未发现残余漏。结论：高原地区室间隔缺损合并肺动脉高压患者经过恰当的围术期处理，施行手术治疗可获得满意的早期疗效。

Objective:To study the early clinical outcome of surgical intervention of ventricular septal defect (VSD) com-plicated with pulmonary hypertension (PH) at high altitude. Metbods:Eighteen VSD patients,including 10 Tibetan and 8 Ti-betan-born Hans with a mean age of 7. 9 years (2-14 years),underwent operative repair at an altitude of 3 700 m. Mild PH wasfound in 2 patients,moderate in 9 and severe in 7. The preoperative arterial blood base excess ranged between-11. 0-4. 3with an average arterial oxygen saturation of 86. 9%. All patients received VSD closure,including 8 cases of patch repair,un-der moderate hemodilutional and tepid CPB. Concomitant procedures included ASD closure performed in 4 patients and PDAligation in 4. Modified De Vega's tricuspid annuloplasty was done in 7 patients. Results:There was no operative death. Thir-teen patients were early extubated within 6 h of arrival at the surgical intensive care unit. Only one patient with severe preop-erative PH experienced postoperative pulmonary hypertensive crises. No significant postoperative pulmonary,renal or neuro-logical complications occurred. All patients were discharged 8-11 d after operation. Neither residual VSD nor ASD has beendocumented by echocardiographic evaluation at the discharge. Conclusion:Surgical repair of ventricular septal defect with pul-monary hypertension under tepid CPB can achieve a satisfying early clinical outcome at the high altitude due to the proper pe-rioperative management.