CAJ | 학술논문

目的评价吸入伊洛前列素对先天性心脏病矫治术患者体外循环后肺动脉高压的影响.方法选择体外循环下先天性心脏病矫治术患者58例,年龄14～60岁,气管插管后右颈内静脉置漂浮导管监测肺动脉压.体外循环下行先天性心脏病矫治术,体外循环结束后平均肺动脉压仍>25mm Hg,此时通过压缩式雾化器吸入伊洛前列素10μg,于吸药前即刻(T_0)、吸药完毕后即刻,吸药完毕后5、15、30和60min时监测心率、右房压、肺小动脉楔压、平均肺动脉压、平均桡动脉压、肺血管阻力和体循环阻力、心输出量及混合静脉血氧饱和度.结果先天性心脏病矫治术患者体外循环后存在肺动脉高压患者28例.与吸药前即刻比较,吸药完毕后各时点患者平均肺动脉压和肺血管阻力明显降低,心输出量和吸药完毕后即刻、5 min时混合静脉血氧饱和度明显升高(P<0.05或0.01).结论体外循环结束后吸入伊洛前列素可有效降低先天性心脏病矫治术患者肺动脉压和肺血管阻力,有助于患者安全、顺利地脱离体外循环.
목적 평개흡입이락전렬소대선천성심장병교치술환자체외순배후폐동맥고압적영향.방법 선택체외순배하선천성심장병교치술환자58례,년령14～60세,기관삽관후우경내정맥치표부도관감측폐동맥압.체외순배하행선천성심장병교치술,체외순배결속후평균폐동맥압잉>25mm Hg,차시통과압축식무화기흡입이락전렬소10μg,우흡약전즉각(T_0)、흡약완필후즉각,흡약완필후5、15、30화60min시감측심솔、우방압、폐소동맥설압、평균폐동맥압、평균뇨동맥압、폐혈관조력화체순배조력、심수출량급혼합정맥혈양포화도.결과 선천성심장병교치술환자체외순배후존재폐동맥고압환자28례.여흡약전즉각비교,흡약완필후각시점환자평균폐동맥압화폐혈관조력명현강저,심수출량화흡약완필후즉각、5 min시혼합정맥혈양포화도명현승고(P<0.05혹0.01).결론 체외순배결속후흡입이락전렬소가유효강저선천성심장병교치술환자폐동맥압화폐혈관조력,유조우환자안전、순리지탈리체외순배.
Objective To evaluate the effects of inhaled iloprost on pulmonary hypertension after cardiopulmonary bypass in patients with congenital heart disease undergoing surgical correction of anomaly. Methods Fifty-eight patients with congenital heart disease aged 14-60 yr undergoing surgical correction of anomaly under cardiopulmonary bypass (CPB) were enrolled in this study. Radial artery was cannulated before induction of anesthesia. A 6-lumen pulmonary catheter was placed via right internal jugular vein after tracheal intubation. Their mean pulmonary arterial pressure was still > 25 mm Hg after operation. ECG, HR, BP, CO, PAP and SpO_2 were continuously monitored. Aerosolized iloprost 10 fig was inhaled via nebulizer after CPB. Hemodynamics were measured before iloprost inhalation (baseline) and at 0, 5, 15, 30 and 60 min after the end of iloprost inhalation. Results There were 28 patients with pulmonary hypertension after CPB among the 58 patients with congenital heart disease. Inhalation of iloprost 10μg significantly decreased mPAP, pulmonary vascular resistance and intrapulmonary shunt as compared with the baseline. Iloprost inhalation could also improve significantly CO and the mixed venous oxygen saturation (SvO_2 ). Conclusion Iloprost inhaled after CPB can effectively reduce pulmonary arterial pressure and pulmonary vascular resistance in patients with congenital heart disease undergoing surgical correction of anomaly and help them wean from CPB.