资源描述：
《先天性心脏病合并重度肺动脉高压外科治疗》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
1、先天性心脏病合并重度肺动脉高压外科治疗【摘要】目的探讨先天性心脏病合并重度肺动脉高压的外科治疗经验。方法34例患者均在体外循环下手术治疗,均采用胸部正中切口。房间隔缺损(直径>1.5cm)、室间隔缺损(直径>1.0cm)均采用涤纶片修补;动脉导管未闭在并行循环下切开肺动脉,于导管置入Foley氏尿管注水暂时堵住血流,采用涤纶片修补或双头针褥式缝合。术前给予吸氧、高压氧及前列腺素E1等治疗,术中应用抑肤酶及低温肺保护液肺动脉灌注等手段。结果32例手术顺利,术后肺动脉压下降3.2~5.5kPa。2例术后早期死于不可复
2、性心功能衰竭。死亡率5.9%。结论正确掌握手术适应证,术中减少心肌及肺血管损伤,充分的围术期处理是手术成功的关键。【关键词】先天性心脏病;肺动脉高压;外科,手术SurgicaltreatmentofcongenitalheartdiseasecombinedwithpulmonaryhypertentionZHAOGuo-chang,BAIYu,CHENZhi-jun,etal.TheDepartmentofHeartandChestSurgery,TheFirstAffiliatedHospitalofXinx
3、iangMedicalCollege,Hennan453100,China【Abstract】ObjectiveToexplorethesurgical10treatmentofcongenitalheartdiseasecombinedwithseverepulmonaryhypertension.Methods34patientsreceivedsurgicalrepairsundercardiopulmonarybypass(CPB).Mid-sternalthoracotomywasperformedin
4、allcases.Atrialseptaldefect(ASD),morethanadiameterof1.5cm)andventricularseptaldefect(VSD,morethanadiameterof1.0cm)wererepairedwithdacronpatch.WiththearterialductbeingpatentandthroughthepulmonraryincisionunderparallelCBP,thebloodflowwastemporarilyblockedbyaFol
5、ey’surinarycatheterwithwater-infusedballoonandtheDacronpatchrepairormattresssuturewithdoubleendedneedlewasmadeinoperation.Allpatientsweretreatedpre-operativelywithoxygeninhalationtherapy,hyperbaricoxygenation,prostaglandinE1respectivelyaccordingtothedegreeofp
6、ulmonaryhypertension.Duringcardiopulmonarybypass,pulmonaryarteryperfusionwasperformedwithprotectivesolutioncontainingaprotininforlungprotection.Vasoactivedrugswereroutinelyadministratedpostoperatively.Results32cases10underwentthesurgicaltreatmentsuccessfullyw
7、iththeirpostoperativepulmonaryarterypressuredecreasedby3.2~5.5kPaand2casesdiedofheartfailure.Themortalitywas5.9%.ConclusionThekeytothiskindofsurgicaltreatmentistodefinethesurgicalindicationscorrectly,toreducetheintraoperativemyocardialandpulmonaryvascularinju
8、riesandtotakegoodmeasuresinperioperativetreatment.【Keywords】Congenitalheartdisease;Pulmonaryhypertention;Surgicaltreatment作者单位:453100新乡医学院第一附属医院胸外科(赵国昌陈志军王永连王忠民);新乡医学院病理科(白玉)肺动脉高压是先天性心脏病外
