合并肺动脉高压的老年继发孔型房间隔缺损围术期处理

目的探讨〉50岁（以下简称老年）合并肺动脉高压的继发孔型房间隔缺损患者的围术期处理。方法回顾性分析2006年1月至2015年2月手术治疗合并肺动脉高压的老年继发孔型房间隔缺损患者52例，根据病情，围术期给予综合性降肺动脉压治疗。结果无手术死亡，术后发生右心功能不全6例、低心排综合征3例、呼吸衰竭2例、肺部感染10例、心律失常21例。随访40例，随访时间3个月至6年，心功能良好。结论对合并肺动脉高压的老年继发孔型房间隔缺损患者，严格把握手术指征及合理的围术期综合治疗能降低病死率和并发症的发生，控制心力衰竭是整个围术期处理的关键。

Objective TO summarize the management of f secondary atrial septal defects complicated with pulmonary hypertension in old patients of 50 years old and above （ hereinafter referred to as the ＂old＂ ） .Methods 52 cases of secondary atrial septal defects complicated with pulmonary hypertension were restrospectively reviewed in our hospital from Jan 2006 to Feb 2015.The patients included 15 male and 37 female with an average age of 55.6 years.According to the specific condition, comprehensive perioperative treatment was applied for the patients .Results There was no death during operation.6 cases occurred right ventricular dysfunction, 3 cases low cardiac syndrome, 2 cases respiratory failure, 10 cases pulmonary infection and 21 cases arrhythmiao Totally 40 cases were followed up from 3 months to 6 years.The heart function were all in better status.Conclusion For the old patients with atrial septal defects combined with pulmonary hypertension, strictly grasp the surgical indications and reasonable comprehensive perioperative treatment can reduce the surgical mortality and complications and control of heart failure is the key to the whole perioperative treatment.