高原地区先天性心脏病并发重度肺动脉高压的围术期管理

Perioperative management of congenital heart disease complicated with severe pulmonary artery hypertension in plateau areas

目的： 探讨降低高原地区先天性心脏病并发肺动脉高压患者围术期并发症和手术死亡率的策略，评估吸入一氧化氮（NO）在先天性心脏病并发重度肺动脉高压患儿围术期的治疗效果。方法： 回顾性分析2009年6月-2012年12月我院收治的31例高原地区先天性心脏病并发重度肺动脉高压患者围术期管理经验，分析其术前、术中和术后等治疗因素对患者预后的影响，以及术后患者吸入NO 前后的心率、平均动脉压、中心静脉压、动态肺顺应性及氧合指数的变化。结果： 1例患者死亡，其余30 例患者在经过严格围术期管理及吸入NO 治疗后，心率、血压无明显改变，平均超声肺动脉压力、动态肺顺应性、氧合指数比治疗前明显改善，有统计学意义。结论： 严密的围术期管理及NO吸入治疗对治疗高原地区先天性心脏病并发重度肺动脉高压患者具有较好的临床效果。

AIM： To explore the perioperative management of severe pulmonary artery hypertension （PAH） of congenital heart disease to decrease complication ratio and mortality in plateau areas and evaluate the treatment effect of inhaled nitric oxide （iNO）. METHODS： Clinical data such as heart rate, mean arterial blood pressure, central venous pressure, pulmonary dynamic compliance and oxygenation index of 31 patients treated with iNO from June 2009 to December 2012 were analyzed retrospectively. RESULTS： After perioperative management including iNO treatment, one patient died （3.25%） and pulmonary dynamic compliance and oxygenation index in the other 30 patients increased significantly （ P 〈 0. 05 ）. Average ultrasonic pulmonary artery pressure （SPAP） decreased significantly （ P 〈 0. 05 ）. CONCLUSION： Appropriate perioperative management and NO inhalation are effective in treatment of CHD patients with PAH in plateau areas.