中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2011年
4期
255-261
,共7页
心脏病,先天性%室间隔缺损%危险因素
心髒病,先天性%室間隔缺損%危險因素
심장병,선천성%실간격결손%위험인소
Heart disease,congenital%Ventricular septal defects%Risk factor
目的 探求室间隔缺损、肺高压患儿术后反应性肺高压的发生率、危险因素.评估术后反应性肺高压的治疗效果.方法 对1991年至2006期间术前诊断室间隔缺损、肺高压在我科接受室间隔缺损修补术患儿的客观病史资料进行回顾性研究.搜集患儿围术期客观指标进行统计和分析,评估术后早期疗效.探求术后反应性肺高压的危险因素.结果 16年间共2 141例室间隔缺损合并肺高压的患儿纳入本课题.术后住院早期死亡20例,住院晚期死亡3例,术后病情平稳出院2 118例.术后反应性肺高压发生率为6.1%,术后肺高压危象的发生率为2.1%、死亡率为2.3%.术中体外循环时间≥90min(P＜0.01)、主动脉阻断时间≥75min(P＜0.01)、术后残余分流(P＜0.01)是发生术后反应性肺高压的相关危险因素.结论 室间隔缺损、肺高压的患儿术后反应性肺高压的独立危险因素有:术前年龄、Pp/Ps、存在充血性心力衰竭、术后二尖瓣反流中度以上.术后反应性肺高压的患儿更容易依赖儿茶酚胺类药物,左房途径输入儿茶酚胺类药物能增加其强心效果.
目的 探求室間隔缺損、肺高壓患兒術後反應性肺高壓的髮生率、危險因素.評估術後反應性肺高壓的治療效果.方法 對1991年至2006期間術前診斷室間隔缺損、肺高壓在我科接受室間隔缺損脩補術患兒的客觀病史資料進行迴顧性研究.搜集患兒圍術期客觀指標進行統計和分析,評估術後早期療效.探求術後反應性肺高壓的危險因素.結果 16年間共2 141例室間隔缺損閤併肺高壓的患兒納入本課題.術後住院早期死亡20例,住院晚期死亡3例,術後病情平穩齣院2 118例.術後反應性肺高壓髮生率為6.1%,術後肺高壓危象的髮生率為2.1%、死亡率為2.3%.術中體外循環時間≥90min(P＜0.01)、主動脈阻斷時間≥75min(P＜0.01)、術後殘餘分流(P＜0.01)是髮生術後反應性肺高壓的相關危險因素.結論 室間隔缺損、肺高壓的患兒術後反應性肺高壓的獨立危險因素有:術前年齡、Pp/Ps、存在充血性心力衰竭、術後二尖瓣反流中度以上.術後反應性肺高壓的患兒更容易依賴兒茶酚胺類藥物,左房途徑輸入兒茶酚胺類藥物能增加其彊心效果.
목적 탐구실간격결손、폐고압환인술후반응성폐고압적발생솔、위험인소.평고술후반응성폐고압적치료효과.방법 대1991년지2006기간술전진단실간격결손、폐고압재아과접수실간격결손수보술환인적객관병사자료진행회고성연구.수집환인위술기객관지표진행통계화분석,평고술후조기료효.탐구술후반응성폐고압적위험인소.결과 16년간공2 141례실간격결손합병폐고압적환인납입본과제.술후주원조기사망20례,주원만기사망3례,술후병정평은출원2 118례.술후반응성폐고압발생솔위6.1%,술후폐고압위상적발생솔위2.1%、사망솔위2.3%.술중체외순배시간≥90min(P＜0.01)、주동맥조단시간≥75min(P＜0.01)、술후잔여분류(P＜0.01)시발생술후반응성폐고압적상관위험인소.결론 실간격결손、폐고압적환인술후반응성폐고압적독립위험인소유:술전년령、Pp/Ps、존재충혈성심력쇠갈、술후이첨판반류중도이상.술후반응성폐고압적환인경용역의뢰인다분알류약물,좌방도경수입인다분알류약물능증가기강심효과.
Objective To study the risk factors and management for reactive pulmonary hypertension (RPH) after corrective surgery of ventricular septal defect (VSD) in children. Methods From 1991 to 2006, 2141 patients who underwent corrective surgery for VSD were recruited in this study.The patients' clinical data, including patient's gender, age, diagnosis, the ratio of pulmonary pressure to systolic pressure (Pp/Ps), the time of cardiopulmonary bypass (CPB), postoperative RPH, pulmonary hypertension crisis (PHC) and other complications, and the treatment of RPH, were retrospectively analyzed. The risk factors of postoperative RPH were statistically analyzed. The outcomes of RPH treatment were also evaluated. Results Twenty patients died during the early in-hospital period, 3 patients died during the late in-hospital period, and the others were recovered after surgery. The mobility of postoperative RPH and PHC were 6. 12% and 2. 06%, respectively. The overall mortality of the patients was 2. 27%. The patients had CPB≥90 min, aortic clamp time≥75 min, postoperative catecholamines treatment, and residual intracardiac shunting after surgery were more likely to develop postoperative RPH. Conclusions The independent risk factors of postoperative RPH include patients'Pp/Ps ratio, age, congestive heart failure before surgery, moderate mitral regurgitation after surgery.Catecholamines treatment could effectively improve right ventricular function in the patients with RPH.
