牛心包补片修补心脏缺损并雾化吸入伊洛前列环素降低肺动脉高压

Bovine pericardium patch repairs heart defects and aerosolized iloprost reduces pulmonary hypertension

背景:对于先天性心脏病合并肺动脉高压的治疗,传统降低肺动脉高压的药物效果确实,但存在不易监测、停药后反跳等现象;传统的心脏涤纶补片较易引起吻合口变形、血栓、栓塞、溶血和感染等并发症。目的:观察应用戊二醛处理牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压的效果。方法:选择90例先天性心脏病合并肺动脉高压患者,术中采用戊二醛处理的牛心包补片修补心脏间隔缺损,术后雾化吸入伊洛前列环素30 ng/(min·kg),日间12 h按1次/4 h给药,夜间12 h按1次/6 h给药,连续给药2 d。记录每次吸入药物前、吸入后即刻、吸入30 min后平均动脉压、平均肺动脉压、体循环阻力指数与肺循环阻力指数,于随访期观察有无心包材料相关并发症和心功能情况。结果与结论:90例患者复查超声心动图见活瓣均已关闭,无分流,心脏间隔缺损无回声中断,心脏收缩功能正常,未发现与牛心包补片相关的不良反应。所有患者不同时间点平均动脉压、体循环阻力指数比较差异无显著性意义。患者吸入药物后即刻平均肺动脉压、肺循环阻力指数明显低于吸入药物前(P<0.01),吸入30 min后平均肺动脉压、肺循环阻力指数亦明显低于吸入药物前(P<0.05)。表明应用戊二醛处理的牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压安全、有效。

BACKGROUND：The treatment of pulmonary hypertension secondary to congenital heart disease has been a hot topic in the clinical research on cardiac surgery. Although traditional drugs for reducing pulmonary hypertension have excelent effects, there are some defaults, such as difficult monitoring and rebounding phenomenon after drug withdrawal. The traditional heart dacron graft is prone to cause complications, such as deformation, thrombosis, embolism, hemolysis and infection. OBJECTIVE：To investigate the effect of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost in patients with pulmonary hypertension secondary to congenital heart disease. METHODS：Ninety patients with pulmonary hypertension due to congenital heart disease underwent a surgery. Glutaraldehyde-treated bovine pericardium patch were used to repair cardiac septal defect, and then aerosolized iloprost was applied after operation, administered for 3 days according to 30 ng/min/kg, every 4 hours in the first 12 hours of a day, and every 6 hours in the resting 12 hours. Mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance index, pulmonary vascular resistance index were recorded beforeinhalation, immediately after inhalation, and 30 minutes after inhalation. The pericardium-associated complications, and cardiac function were also observed at folow-ups. RESULTS AND CONCLUSION： The involved 90 cases were detected by echocardiography. The results showed that, al the flaps were closed, there was no shunting or echo discontinuation of atrial septum. The heart contraction function was normal. No pericardium-associated complications were found. There was no significant difference in the mean arterial pressure and systemic vascular resistance index in al patients at different time points. The mean pulmonary arterial pressure and pulmonary vascular resistance index immediately after inhalation were significantly lower than that before inhalation （P 〈 0.01）. The decrease was also significant 30 minutes after inhalation （P 〈 0.05）. The intervention of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost is safe and effective to treat patients with pulmonary hypertension secondary to congenital heart disease.