高压氧与术前前列地尔联合治疗先天性心脏病伴重度肺动脉高压的临床效果分析

Analysis of the Effects of Hyperbaric Oxygen Combined with Alprostadil on Congenital Heart Disease Accompanied with Severe Pulmonary Hypertension

目的：观察术前前列地尔联合高压氧（hyperbaricoxygen,HBO）治疗对先天性心脏病伴发重度肺动脉高压患者的临床疗效。方法：按随机数字表法将49例室间隔缺损伴发重度肺动脉高压的患者分为对照组（n=25,常规治疗）和观察组（n=24,常规治疗＋HBO辅助治疗）,常规治疗以多巴胺[3-5μg/（kg·min）]、呋塞米片（5-20 mg/次,3/日）、前列地尔[2-5 ng/（kg·min）]等药物治疗以及常压间断吸氧（每次0.5 h,3次/日）治疗为主。比较2组患者入院时（T1）、术前治疗15 d后（T2）和术后治疗10 d后（T3）三个时间点体肺血流动力学变化。结果：对照组及观察组患者的平均肺动脉压（m PAP）、肺循环阻力（PVR）和肺动脉压/主动脉压比值（Pp/Ps）经术前综合治疗15 d后分别下降为（57.08±9.44）/（53.16±11.61）mm Hg、（943.81±245.86）/（927.21±119.27）dyns/cm5和（0.70±0.17）/（0.68±0.13）,经术后治疗10 d后进一步下降;两组动脉血氧饱和度（Sa O2）术前治疗15 d及术后治疗10 d后均较入院时高升,而平均体循环压（m SAP）和体循环阻力（SVR）经术前治疗15d后（T2）略有下降（P〈0.05）,但在术后10 d（T3）恢复至入院时水平（T1）。与对照组相比,观察组m PAP和PVR值经术前治疗15 d后（T2）下降更显著,Sa O2上升也更为明显（P〈0.05）。结论：对于先天性心脏病伴发重度肺动脉高压的患者,术前给予前列地尔药物降压的同时辅以HBO治疗可有效降低肺动脉压,提高血氧饱和度,可为手术的实施和减少术后并发症提供有利条件。

Objective： To observe the efficacy of preoperative alprostadil combined with hyperbaric oxgen（HBO） on patients with congenital heart disease accompanied with severe pulmonary hypertension. Methods： Forty nine patients with ventricular septal defect accompanied with severe pulmonary hypertension were divided into the control group（n=25, conventional therapy） and the observation group（n=24, conventional therapy ＋ HBO adjuvant therapy）according to random number table method, conventional therapies majorly includedthe dopamine [3-5μg/（kg·min）], furosemide tablets（5-20 mg/time, 3/day）, alprostadil [2 -5 ng/（kg·min）], other medications and atmospheric intermitting oxygen inhalation（0.5 h per time, 3 times/day）. The changes in physical and pulmonary hemodynamics at three points including the time of admission（T1）, 15 days before therapy（T2） and 15 days after treatment（T3） were compared. Results：Mean pulmonary artery pressure（m PAP）, pulmonary vascular resistance（PVR） and ratio of pulmonary artery pressure/aortic pressure（Pp/Ps） of the two group after preoperative comprehensive treatment respectively decreased to（57.08 ±9.44）/（53.16±11.61）mm Hg,（943.81 ±245.86）/（927.21 ±119.27） dyns/cm5and（0.70 ±0.17）/（0.68 ±0.13）, and such indexes further fell after surgeries and postoperative comprehensive therapies;Arterial blood oxygen saturation（Sa O2） gradually increased during the treatment, mean systemic pressure（m SAP） and systemic vascular resistance（SVR） in（T2） days after treatment slightly decreased（P〈0.05）, but such indexes in postoperative 10 days（T3） recovered to the level of admission at（T1）. The decrease in（T2）m PAP and PVR of patients in the observation group in 15 days upon preoperative treatment became more significant when compared to such indexes of patients in the control group,while the increase in Sa O2 of patients in the observation group was more significant（P〈0.05）. Conclusions： The medication anti-hypertension of alprostadil supplemented with HBO therapy on the patients with congenital heart disease accompanied with severe pulmonary hypertension can effectively reduce the pulmonary artery pressure and increase the blood oxygen saturation, thereby providing a more powerful increase the the implementation of surgeries and the decrease in postoperative complications