中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
10期
727-730
,共4页
顾虹%李强强%张陈%刘天洋%卓玲%刘海菊%郭保静%侯嘉%张辉%伊放%罗毅
顧虹%李彊彊%張陳%劉天洋%卓玲%劉海菊%郭保靜%侯嘉%張輝%伊放%囉毅
고홍%리강강%장진%류천양%탁령%류해국%곽보정%후가%장휘%이방%라의
心脏缺损,先天性%高血压,肺性%心脏导管插入术%伊洛前列素
心髒缺損,先天性%高血壓,肺性%心髒導管插入術%伊洛前列素
심장결손,선천성%고혈압,폐성%심장도관삽입술%이락전렬소
Heart defects,congenital%Hypertension,pulmonary%Heart catheterization%Iloprost
目的 评价吸入伊洛前列素的急性肺血管扩张试验在先天性心脏病(CHD)肺动脉高压(PH)患者心脏外科手术适应证选择中的作用.方法 对2006年6月至2008年12月46例CHD合并重度PH患者的临床资料进行回顾性分析.其中男性15例,女性31例,平均年龄(12±9)岁.所有患者术前均接受心导管检查和吸入伊洛前列索试验,患者平均肺动脉压(mPAP)(80±13)mm Hg(1 mill Hg=0.133 kPa),平均肺小动脉阻力指数(PVRI)(17±10)wood·m2.将吸入伊洛前列素试验肺血管阳性反应定义为在体循环压力不变或上升的情况下,PVRI下降≥20%,并作为选择手术适应证的重要条件.药物试验阳性患者在心脏外科修补术后均放置肺动脉漂浮导管,监测术后肺动脉压力、阻力以及心功能状况.结果 46例患者中,药物试验阳性29例(63.1%),吸药后PVRI由(15±6)wood·m2降至(9-4-4)wood·m2,肺循环体循环阻力比(Rp/Rs)由0.7±0.2降至0.4±0.2(P值均<0.05).药物试验反应阴性者17例(36.9%),吸药后PVRI由(21±10)wood·m2降至(19±9)wood·m2(P<0.05),Rp/Rs由1.0±0.5降至0.9±0.5(P>0.05).23例患者接受了心脏外科手术治疗,全部存活.其中药物试验阳性组21例,术后mPAP降至(27±10)mm Hg.药物试验阴性组仅2例接受外科修补术,术后mPAP均>45 mm Hg.结论 吸入伊洛前列素试验阳性患者术后肺动脉压力和PVRI明显降低,可作为评价合并PH的CHD手术适应证的一种蕈要手段.
目的 評價吸入伊洛前列素的急性肺血管擴張試驗在先天性心髒病(CHD)肺動脈高壓(PH)患者心髒外科手術適應證選擇中的作用.方法 對2006年6月至2008年12月46例CHD閤併重度PH患者的臨床資料進行迴顧性分析.其中男性15例,女性31例,平均年齡(12±9)歲.所有患者術前均接受心導管檢查和吸入伊洛前列索試驗,患者平均肺動脈壓(mPAP)(80±13)mm Hg(1 mill Hg=0.133 kPa),平均肺小動脈阻力指數(PVRI)(17±10)wood·m2.將吸入伊洛前列素試驗肺血管暘性反應定義為在體循環壓力不變或上升的情況下,PVRI下降≥20%,併作為選擇手術適應證的重要條件.藥物試驗暘性患者在心髒外科脩補術後均放置肺動脈漂浮導管,鑑測術後肺動脈壓力、阻力以及心功能狀況.結果 46例患者中,藥物試驗暘性29例(63.1%),吸藥後PVRI由(15±6)wood·m2降至(9-4-4)wood·m2,肺循環體循環阻力比(Rp/Rs)由0.7±0.2降至0.4±0.2(P值均<0.05).藥物試驗反應陰性者17例(36.9%),吸藥後PVRI由(21±10)wood·m2降至(19±9)wood·m2(P<0.05),Rp/Rs由1.0±0.5降至0.9±0.5(P>0.05).23例患者接受瞭心髒外科手術治療,全部存活.其中藥物試驗暘性組21例,術後mPAP降至(27±10)mm Hg.藥物試驗陰性組僅2例接受外科脩補術,術後mPAP均>45 mm Hg.結論 吸入伊洛前列素試驗暘性患者術後肺動脈壓力和PVRI明顯降低,可作為評價閤併PH的CHD手術適應證的一種蕈要手段.
목적 평개흡입이락전렬소적급성폐혈관확장시험재선천성심장병(CHD)폐동맥고압(PH)환자심장외과수술괄응증선택중적작용.방법 대2006년6월지2008년12월46례CHD합병중도PH환자적림상자료진행회고성분석.기중남성15례,녀성31례,평균년령(12±9)세.소유환자술전균접수심도관검사화흡입이락전렬색시험,환자평균폐동맥압(mPAP)(80±13)mm Hg(1 mill Hg=0.133 kPa),평균폐소동맥조력지수(PVRI)(17±10)wood·m2.장흡입이락전렬소시험폐혈관양성반응정의위재체순배압력불변혹상승적정황하,PVRI하강≥20%,병작위선택수술괄응증적중요조건.약물시험양성환자재심장외과수보술후균방치폐동맥표부도관,감측술후폐동맥압력、조력이급심공능상황.결과 46례환자중,약물시험양성29례(63.1%),흡약후PVRI유(15±6)wood·m2강지(9-4-4)wood·m2,폐순배체순배조력비(Rp/Rs)유0.7±0.2강지0.4±0.2(P치균<0.05).약물시험반응음성자17례(36.9%),흡약후PVRI유(21±10)wood·m2강지(19±9)wood·m2(P<0.05),Rp/Rs유1.0±0.5강지0.9±0.5(P>0.05).23례환자접수료심장외과수술치료,전부존활.기중약물시험양성조21례,술후mPAP강지(27±10)mm Hg.약물시험음성조부2례접수외과수보술,술후mPAP균>45 mm Hg.결론 흡입이락전렬소시험양성환자술후폐동맥압력화PVRI명현강저,가작위평개합병PH적CHD수술괄응증적일충심요수단.
Objective To evaluate the efficacy of iloprost in acute vasodilatation test during cardiac catheterization and to explore a useful hemodynamic indication regarding operability in the patients with severe pulmonary hypertension (PH) related to congenital heart disease (CHD). Methods The clinical data of 46 patients [mean age (12 ±9) years] with severe PH related to CHD from June 2006 to December 2008 was retrospectively analyzed. All patients underwent standard right and left cardiac catheterization and a trial of inhaled iloprost test during cardiac catheterization. The mean pulmonary arterial pressure was (80 ±13) mm Hg ( 1 mm Hg = 0.133 kPa) and pulmonary vascular resistance index was ( 17 ± 10 ) wood · m2.A positive response to inhaled iloprost was defined as a decrease of at least 20% in pulmonary vascular resistance index ( PVRI) without changes on systemic artery pressure. Patients with positive response to iloprost underwent cardiac surgical repair. The pulmonary artery pressure and PVRI was monitored by Swan- Ganz catheter postoperatively. Results Of the 46 patients, 29 (63.1% ) showed a positive response after iloprost inhalation, defined by a significant reduction in PVRI from (15 ±6) wood · m2 at baseline to(9 ±4) wood · m2 in response to iloprost inhalation therapy (P < 0. 05). The ratio of pulmonary to systemic resistance ( Rp/Rs) decreased from 0. 7 ± 0. 2 to 0.4 ± 0. 2 (P < 0. 05 ). Seventeen patients (36. 9% ) didn't respond to iloprost displayed only little changes in PVRI [from (21 ±10) wood · m2 to (19 ±9) wood · m2] and Rp/Rs (from 1. 0 ± 0. 5 to 0. 9 ± 0. 5). Out of 29 positive patients, 21 (72% ) underwent successful cardiac surgical repair with a reduction of mean pulmonary arterial pressure ( mPAP) to an average of (27 ± 10) mm Hg after the operation. Only 2 patients out of the 17 patients from the negative group were referred to surgery. Their mPAP was greater than 45 mm Hg. Conclusions A significant reduction in pulmonary artery pressure after cardiac surgery was observed in patients with positive response to inhaled iloprost. Inhaled iloprost may be a valuable tool in the preoperative evaluation of patients with severe PH related to CHD.
