心血管外科杂志(电子版)
心血管外科雜誌(電子版)
심혈관외과잡지(전자판)
Journal of Cardiovascular Surgery(Electronic Edition)
2014年
1期
19-22
,共4页
成革胜%张玉顺%杜亚娟%何璐%王星烨
成革勝%張玉順%杜亞娟%何璐%王星燁
성혁성%장옥순%두아연%하로%왕성엽
心脏缺损,先天性%高血压,肺性%放射学,介入性%靶向药物
心髒缺損,先天性%高血壓,肺性%放射學,介入性%靶嚮藥物
심장결손,선천성%고혈압,폐성%방사학,개입성%파향약물
Heart defects,congenital%Hypertension,pulmonary%Radiology,interventional%Targeted therapy
目的探讨靶向药物联合介入治疗先天性心脏病合并重度肺动脉高压患者的安全性及疗效,寻求合理的治疗方案。方法回顾分析采用靶向药物联合介入封堵治疗的23例先天性心脏病合并重度肺动脉高压患者临床资料并随访观察。结果23例中PDA 19例,ASD 1例,PDA并ASD 2例,PDA并VSD 1例。封堵成功14例,其中即刻封堵11例,延期封堵3例。封堵后与封堵前比较患者股动脉血氧饱和度由(90.4±2.7)%升至(93.1±2.2)%(P<0.01),肺动脉收缩压由(104.8±16.5)mm Hg降至(82.3±33.9) mm Hg(P<0.01),主动脉压由(137.1±14.7)mm Hg升高至(140.5±18.1)mm Hg(P>0.05)。封堵失败9例,其中右心导管检查后股动脉氧饱和度<90%且PVR>15 wood者6例,试封堵后肺动脉收缩压无明显下降甚至升高者3例。平均随访(38.3±20.9)个月,无死亡病例。14例中13例封堵术后肺动脉收缩压持续下降至正常水平,其中1例肺动脉收缩压逐渐上升至90 mm Hg,6 min步行试验距离由术前(343±102) m增加至(505±87)m(P<0.05)。9例未封堵患者肺动脉收缩压由(114.2±36.6)mm Hg降至(108.3±32.7) mm Hg(P>0.05),6 min步行试验距离由术前(316±103)m增加至(386±95)m(P<0.05)。结论靶向药物联合介入治疗先天性心脏病合并重度肺动脉高压是安全的,效果较好。封堵前的综合评估及围手术期规范治疗是患者获益的最大保证。
目的探討靶嚮藥物聯閤介入治療先天性心髒病閤併重度肺動脈高壓患者的安全性及療效,尋求閤理的治療方案。方法迴顧分析採用靶嚮藥物聯閤介入封堵治療的23例先天性心髒病閤併重度肺動脈高壓患者臨床資料併隨訪觀察。結果23例中PDA 19例,ASD 1例,PDA併ASD 2例,PDA併VSD 1例。封堵成功14例,其中即刻封堵11例,延期封堵3例。封堵後與封堵前比較患者股動脈血氧飽和度由(90.4±2.7)%升至(93.1±2.2)%(P<0.01),肺動脈收縮壓由(104.8±16.5)mm Hg降至(82.3±33.9) mm Hg(P<0.01),主動脈壓由(137.1±14.7)mm Hg升高至(140.5±18.1)mm Hg(P>0.05)。封堵失敗9例,其中右心導管檢查後股動脈氧飽和度<90%且PVR>15 wood者6例,試封堵後肺動脈收縮壓無明顯下降甚至升高者3例。平均隨訪(38.3±20.9)箇月,無死亡病例。14例中13例封堵術後肺動脈收縮壓持續下降至正常水平,其中1例肺動脈收縮壓逐漸上升至90 mm Hg,6 min步行試驗距離由術前(343±102) m增加至(505±87)m(P<0.05)。9例未封堵患者肺動脈收縮壓由(114.2±36.6)mm Hg降至(108.3±32.7) mm Hg(P>0.05),6 min步行試驗距離由術前(316±103)m增加至(386±95)m(P<0.05)。結論靶嚮藥物聯閤介入治療先天性心髒病閤併重度肺動脈高壓是安全的,效果較好。封堵前的綜閤評估及圍手術期規範治療是患者穫益的最大保證。
목적탐토파향약물연합개입치료선천성심장병합병중도폐동맥고압환자적안전성급료효,심구합리적치료방안。방법회고분석채용파향약물연합개입봉도치료적23례선천성심장병합병중도폐동맥고압환자림상자료병수방관찰。결과23례중PDA 19례,ASD 1례,PDA병ASD 2례,PDA병VSD 1례。봉도성공14례,기중즉각봉도11례,연기봉도3례。봉도후여봉도전비교환자고동맥혈양포화도유(90.4±2.7)%승지(93.1±2.2)%(P<0.01),폐동맥수축압유(104.8±16.5)mm Hg강지(82.3±33.9) mm Hg(P<0.01),주동맥압유(137.1±14.7)mm Hg승고지(140.5±18.1)mm Hg(P>0.05)。봉도실패9례,기중우심도관검사후고동맥양포화도<90%차PVR>15 wood자6례,시봉도후폐동맥수축압무명현하강심지승고자3례。평균수방(38.3±20.9)개월,무사망병례。14례중13례봉도술후폐동맥수축압지속하강지정상수평,기중1례폐동맥수축압축점상승지90 mm Hg,6 min보행시험거리유술전(343±102) m증가지(505±87)m(P<0.05)。9례미봉도환자폐동맥수축압유(114.2±36.6)mm Hg강지(108.3±32.7) mm Hg(P>0.05),6 min보행시험거리유술전(316±103)m증가지(386±95)m(P<0.05)。결론파향약물연합개입치료선천성심장병합병중도폐동맥고압시안전적,효과교호。봉도전적종합평고급위수술기규범치료시환자획익적최대보증。
Objective To study the safety and efficacy of targeted drugs and interventional treatment of congenital heart disease and severe pulmonary hypertension .Methods The clinical data and experience in 23 patients with congenital heart disease and severe pulmonary hypertension ( PAH-CHD ) were reviewed from March 2008 to June 2012 .Results In all 23 patients ,19 cases were PDA ,1 case was ASD ,2 cases were PDA and ASD , 1 case was PDA and the VSD .14 cases were successfully occluded ,and 9 inoperable patients .Compared with the level before operation , femoral arterial oxygen saturation was higher ( P<0.01 ) , and pulmonary artery systolic pressure was lower(P<0.01),the aortic pressure was higher(P>0.05).No deaths after average(38.3 ±20.9) months follow-up.13 patients in 14 operable cases were found to have no postoperative PAH ,and 6 minutes walk test distance was higher ( P<0.05 ) .In 9 inoperable patients ,the pulmonary artery systolic pressure was lower ( P>0.05 ) , 6 minutes walk test distance was higher ( P <0.05 ) .Conclusion Targeting therapy and interventional treatment for congenital heart disease with severe pulmonary hypertension are safe and effective .