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1、室间隔缺损合并重度肺动脉高压围手术期处理杨盛春周其文 来永强 陈英淳 宋瑞 心肺血管病杂志2002年11月第21卷第4期 JournalofCardiovascular&PulmonaryDiseases,November2002,Vol.21,No.4〔摘要〕 目的:评估室间隔缺损合并重度肺动脉高压手术治疗围手术期处理的效果。方法:选择55北京安贞医院心脏外科来永强例室间隔缺损合并重度肺动脉高压病例,在手术时放置Swan2ganz导管,术后进行肺动脉压监测;20例用单向活瓣补片修补室缺,术后用超声心动图监测分流情况;用镇静,肌松,过度
2、通气,血管扩张剂等治疗肺动脉高压危象。结果:发现7例持续肺动脉高压,死亡2例;27例有肺动脉高压危象,死亡2例;在严重肺动脉高压时,单向活瓣补片有右向左分流,肺动脉压下降后分流停止,未发现左向右分流。结论:室间隔缺损合并重度肺动脉高压应把握好手术适应症,有不可逆的肺动脉高压患者禁止手术;Swan-ganz导管在术后肺动脉高压处理上有重要作用;单向活瓣补片修补室缺能在术后发生重度肺动脉高压时发挥良好的右向左单向分流作用,肺动脉压下降后又能自动关闭。〔关键词〕 高血压,肺性 室间隔缺损 手术期间Perioperativetreatmentfor
3、ventricularseptaldefectcomplicatedwithseverepulmonaryhypertention YANGShengchun,ZHOUQiwen,LAIYongqiang,etal.DepartmentofCardiovascularsurgery,AnzhenHospital,Beijing100029[Abstract] Objective:Toevaluatetheoutcomeofperioperativetreatmentforventricularseptaldefectcomplicatedw
4、ithseverepulmonaryhypertention.Method:Duringoperations,fiftyfiveVSDcaseswereinsertedSwan-ganzcatheterintopulmonaryarteryinordertomonitorpulmonarypressureimmediatelyafteroperation.TwentycasesofVSDwererepairedwithunidirectionalpatch.UCGwereusedtomonitortheshuntpenetratingthe
5、patch.Treatingpulmonaryhypertensivecrisesbysedating,paralyzing,hyperventilation,pulmonaryvasculardilation.Result:7casesfoundedtobeirreversiblepulmonaryhypertention,2died.In27cases,pulmonaryhypertensivecrisesweremonitored,2died.Right-to-leftshuntingswerefoundedpenetratingun
6、ldirectionalpatchswhenseverepulmonaryhypertentionoccurred,theshuntsdisappearedspontaneously;Whenpulmonarypressurelowered,noleft2torightshuntwasfounded.Conclusion:VSDwithirreversiblepulmonaryhypertensionisnotsuitableforrepair;Swan2ganzductplaysanimprotantroleinthetreatmentf
7、orpostoperativepulmonaryhypertension;Sedating,paralyzing,hyperventilation,pulmonaryvasculardilationarethefundmentalmeasuresforthetreatmentofpostoperativepulmonaryhypertension.Unidirectionalpatchshuntbloodtoleftventriclefromrightventriclewhileseverepulmonaryhypertensionoccu
8、rs.Theshuntdisappearwhenpulmonarypressurelower.obloodpenetrateunidirectionalpatchnomatter
