老年先天性心脏病并发重度肺动脉高压外科手术治疗与保守治疗临床效果比较

Comparison of clinical effect between surgical treatment and conservative treatment for elderly patients with congenital heart disease complicated with severe pulmonary artery hypertension

目的比较老年先天性心脏病(CHD)并发重度肺动脉高压(PAH)外科手术治疗与保守治疗的治疗效果,探讨外科手术治疗老年CHD伴重度PAH的可行性和安全性。方法选取2011年9月至2013年4月首都医科大学附属北京安贞医院收治的CHD并发重度PAH老年患者126例,其中63例给予外科手术治疗(手术治疗组),63例给予保守治疗(保守治疗组),比较2组患者心排血指数、肺动脉压、并发症及存活率。结果治疗前2组患者平均肺动脉压(MPAP)及心排血指数比较差异均无统计学意义(P>0.05);治疗后2组患者MPAP显著降低(P<0.05),心排血指数显著升高(P<0.05);治疗后手术治疗组患者MPAP显著低于保守治疗组(P<0.05),心排血指数显著高于保守治疗组(P<0.05)。手术治疗组和保守治疗组并发症发生率分别为41.27%(26/63)和60.32%(38/63),手术治疗组患者并发症发生率低于保守治疗组(P<0.05)。手术治疗组患者3个月、6个月及1 a生存率分别为92.06%(58/63)、77.78%(49/63)和61.90%(39/63);保守治疗组患者3个月、6个月及1 a生存率分别为79.37%(50/63)、60.32%(38/63)和42.86%(27/63);手术治疗组患者3个月、6个月及1a生存率均高于保守治疗组(P<0.05)。结论外科手术治疗能够显著增加CHD并发重度PAH患者的心排血量,降低肺动脉压,减少并发症,提高生存率。

Objective To investigate the feasibility and safety of surgical treatment for elderly patients with congenital heart disease（CHD） complicated with severe pulmonary artery hypertension（PAH） by comparing the effect between surgical treatment and conservative treatment. Methods A total of 126 elderly patients with CHD complicated with PAH were selected in Beijing Anzhen Hospital Affiliated to Capital Medical University from September 2011 to April 2013. Among the patients, sixty-three patients were treated with surgery（ surgery group） , and sixty-three patients were treated with conservative treatment （conservative treatment group）. The cardiac output index, pulmonary artery pressure, complication and survival rate were com- pared between the two groups. Results There was no significant difference in the mean pulmonary arterial pressure（MPAP） and cardiac output index between the two groups （ P 〉 0.05 ）. After treatment, the MPAP decreased significantly （ P 〈 0.05 ）, and the cardiac output index increased significantly in the two groups （P 〈 0.05 ）. After treatment, the MPAP in surgery group was significantly lower than that in conservative treatment group （P 〈 0.05 ）, but the cardiac output index in surgery group was significantly higher than that in conservative treatment group（ P 〈 0.05 ）. The incidence rate of complication in surgery group and conservative treatment group was 41.27% （26/63） and 60.32% （38/63） respectively, the incidence rate of complication in surgery group was lower than that in conservative treatment group（ P 〈 0.05 ）. The 3-month ,6-month and 1-year survival rate in surgery group was 92.06% （ 58/63 ） ,77.78% （49/63） and 61.90% （ 39/63 ） respectively; and the survival rate in conser- vative treatment group was 79.37% （50/63） ,60.32% （38/63） and 42.86% （27/63） respectively;the 3-month,6-month and 1-year survival rate in surgery group were higher than those in conservative treatment group（ P 〈 O. 05 ）. Conclusion Surgical treatment can significantly increase the cardiac output index, decrease the pulmonary arterial pressure and complications, and improve the survival rate of patients with CHD complicated with PAH.