中国实用儿科杂志

中国实用儿科杂志 ›› 2011, Vol. 26 ›› Issue (02): 101-.

• 论著 • 上一篇    下一篇

完全性房室间隔缺损合并肺动脉高压术后75例预后分析

  

  1. 1. 上海市儿童医院，上海交通大学附属儿童医院，上海　200040；2. 上海交通大学医学院附属上海儿童医学中心，上海　200127
  • 出版日期:2011-02-06 发布日期:2011-03-03

Postoperative follow-up of patients with complete atrioventricular septal defect complicated with pulmonary hypertension.　　

  1. Shanghai Children’s Hospital，Children’s Hospital of Shanghai Jiaotong University， Shanghai 200040，China
  • Online:2011-02-06 Published:2011-03-03

摘要：

探讨完全性房室间隔缺损（CAVSD）合并肺动脉高压术后的疗效。方法　对2003年1月至2007年3月在上海儿童医学中心行CAVSD合并肺动脉高压修补术的75例患儿进行随访分析。患儿术前行心导管检查，了解肺动脉压力及肺小动脉阻力（PAR）。通过超声心动图心尖四腔切面评估术前，术后第2天、1个月、6个月及1年肺动脉高压的情况。记录术后监护时间、呼吸机使用时间及肺动脉高压危象发生情况。结果　75例CAVSD患儿术后监护（4.9±2.1） d，呼吸机使用（2.1±0.9） d，出现肺动脉高压危象12例（16%）。PAR > 8 Wood 单位患儿与PAR≤8 Wood 单位患儿比较，年龄较大，术后监护时间、呼吸机维持时间较长，肺动脉高压危象发生率较高 （P均 < 0.05）。院内死亡5例，其中4例的共同瓣严重发育不良。75例患儿中，术后第2天彩超评估39例（52%）肺动脉压力降至正常，51例（68%）于术后1个月肺动脉压力降至正常，64例（85%）于术后6个月肺动脉压力降至正常；68例（91%）于术后1年肺动脉压力降至正常，余7例术后1年仍合并肺动脉高压。结论　CAVSD早期修补术安全、有效。术前PAR > 8 Wood 单位患儿术后易出现肺动脉高压危象。

关键词: 心脏缺损, 先天性； 心间隔缺损

Abstract:

To observe the operative efficacy in patients with complete atrioventricular septal defect compliated with pulmonary hypertension. Methods　From January 2003 to March 2007， CAVSD patients with pulmonary hypertension who underwent operative closure wereincluded in this study. Color Doppler with apical four-chamber view was used to evaluate the degree of pulmonary hypertension before surgery and 2 days， 1 month， 6 month and 1 year after the surgery. Cardiac catheterization was performed to evaluate pulmonary artery pressure and pulmonary arteriolar resistance （PAR） before surgery in patients whose age were over 6 months. The time of staying at ICU， ventilation time after surgery and the occurrence of pulmonary artery hypertension crisis were recorded. Results　A total of 75 CAVSD patients whounderwent operative closure were enrolled in this study. The mean staying time at ICU was （4.9±2.1）days， and the mean ventilation time was （2.1±0.9） days；12 patients developed pulmonary artery hypertension crisis after surgery. Patients with PAR > 8 wood unit were older，staying time at ICU and ventilation time were longer compared with patients with PAR < 8 wood unit （all P < 0.05）. The incidence of pulmonary artery hypertension crisis after surgery was also significantly higher in patients with PAR > 8 wood unit compared with patients with PAR < 8 wood unit（P < 0.05）. Five patients died. Four out of 5 hospital-dead patients had severe hypoplasia of the atrioventricular valve. Pulmonary artery pressure of 39 patients（52%） returned to normal two days after surgery， 51 patients（68%） returned to normal one month after surgery， 64 patients（85%） returned to normal 6 months after surgery， and 68 patients（91%） returned to normal one year after surgery； 7 patients have pulmonary hypertension one year after surgery. Conclusion　Our results suggest that early surgical repair for CAVC is safe and beneficial. Preoperative PAR > 8 wood unit is associated with increased risk of pulmonary artery hypertension crisis after surgery.

Key words: heart defects, congenital； heart septal defects