CAJ | 학술논문

目的研究前列腺素E1脂质微球(PGE1)对婴幼儿室间隔缺损(VSD)并重度肺动脉高压(PAH)围手术期血流动力学及氧代谢的影响.方法选择VSD合并重度PAH体外循环下矫治术患儿40例,年龄(7.1±3.3)岁.分为对照组(20例)和试验组(20例),围术期分别经中心静脉持续泵入硝酸甘油和PGE1.通过测定、计算血流动力学和氧代谢指标,研究VSD合并重度PAH患儿围术期72 h静脉应用PGE1对血流动力学指标和氧代谢指标的影响及变化趋势.结果 2组比较体动脉平均压(mABP)、肺动脉平均压(mPAP)、mPAP/mABP、肺血管阻力指数(PVRI)、左心室每搏功指数(LVSWI)在术毕至72 h的变化趋势差异有统计学意义(P＜0.05).与对照组比较,试验组mABP术毕48 h升高,差异有统计学意义(P ＜0.05);mPAP术毕8h和48 h降低,差异有统计学意义;PVRI术毕72 h降低,差异有统计学意义(P＜0.05);肺动脉嵌压(PAWP)术毕12～48 h持续降低,差异有统计学意义(P＜0.05);LVSWI术毕48 h和72 h升高,差异有统计学意义(P＜0.05).与术毕即刻比较,对照组mABP术毕12 h和72 h升高,差异有统计学意义(P ＜0.05);mPAP术毕4 ～12 h和术毕48 h升高,差异有统计学意义(P＜0.05);而试验组mABP和LVSWI术毕8～72 h升高,差异有统计学意义(P＜0.05);mPAP无变化;mPAP/mABP术毕24 ～ 72 h明显降低,差异有统计学意义(P＜0.05);PVRI和PAWP术毕72 h降低,差异有统计学意义(P＜0.05);右心室每搏功指数术毕48 h和72 h升高,差异有统计学意义(P＜0.05);心排指数术毕72 h升高,差异有统计学意义(P＜0.05).氧代谢指标2组间比较差异无统计学意义(P＞0.05).结论婴幼儿VSD合并重度PAH围手术期应用PGE1可有效降低肺动脉压,对体循环压力影响小,增加心脏做功,减少术后气管插管时间.
목적 연구전렬선소E1지질미구(PGE1)대영유인실간격결손(VSD)병중도폐동맥고압(PAH)위수술기혈류동역학급양대사적영향.방법 선택VSD합병중도PAH체외순배하교치술환인40례,년령(7.1±3.3)세.분위대조조(20례)화시험조(20례),위술기분별경중심정맥지속빙입초산감유화PGE1.통과측정、계산혈류동역학화양대사지표,연구VSD합병중도PAH환인위술기72 h정맥응용PGE1대혈류동역학지표화양대사지표적영향급변화추세.결과 2조비교체동맥평균압(mABP)、폐동맥평균압(mPAP)、mPAP/mABP、폐혈관조력지수(PVRI)、좌심실매박공지수(LVSWI)재술필지72 h적변화추세차이유통계학의의(P＜0.05).여대조조비교,시험조mABP술필48 h승고,차이유통계학의의(P ＜0.05);mPAP술필8h화48 h강저,차이유통계학의의;PVRI술필72 h강저,차이유통계학의의(P＜0.05);폐동맥감압(PAWP)술필12～48 h지속강저,차이유통계학의의(P＜0.05);LVSWI술필48 h화72 h승고,차이유통계학의의(P＜0.05).여술필즉각비교,대조조mABP술필12 h화72 h승고,차이유통계학의의(P ＜0.05);mPAP술필4 ～12 h화술필48 h승고,차이유통계학의의(P＜0.05);이시험조mABP화LVSWI술필8～72 h승고,차이유통계학의의(P＜0.05);mPAP무변화;mPAP/mABP술필24 ～ 72 h명현강저,차이유통계학의의(P＜0.05);PVRI화PAWP술필72 h강저,차이유통계학의의(P＜0.05);우심실매박공지수술필48 h화72 h승고,차이유통계학의의(P＜0.05);심배지수술필72 h승고,차이유통계학의의(P＜0.05).양대사지표2조간비교차이무통계학의의(P＞0.05).결론 영유인VSD합병중도PAH위수술기응용PGE1가유효강저폐동맥압,대체순배압력영향소,증가심장주공,감소술후기관삽관시간.
Objective To measure the effect of prostaglandin E1 (PGE1) lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect(VSD)and severe pulmonary artery hypertension (PAH).Methods Forty infants [(7.1 ± 3.3) years old] with VSD and severe PAH who underwent surgery under cardiopulmonary bypass were involved in the study.They were divided into 2 groups averagely:control group (20 cases) and experimental group (20 cases).All the patients were continuously intravenous pumping of nitroglycerin or PGE1 during the perioperative period.The effect of PGE1 on cardiac haemodynamics and oxygen metabolism between the 2 groups were measured during 72 hours postoperatively.Results The statistical analysis demonstrated that the values trend of mean arterial blood pressure (mABP),mean pulmonary arterial pressure (mPAP),mPAP/mABP,pulmonary vascular resistance index (PVRI),left ventricular stroke work index (LVSWI) were affected during 72 h postoperative period (P ＜0.05).The mABP at 48 h,LVSWI at 48 h,72 h in experimental group were significantly higher than those in control group (all P ＜0.05).The mPAP at 8 h,48 h,PVRI at 72 h and pulmonary arterial wedge pressure (PAWP)at 12-48 h in experimental group were significantly lower than that in control group (all P ＜ 0.05).Compared to postoperative period,mABP at 12 h,72 h,mPAP at 4-12 h,48 h were increased significantly in control group (P ＜ 0.05) ; mABP and LVSWI at 8-72 h,right ventricular stroke work index at 48 h,72 h and cardiac index at 72 h were significantly increased (P ＜0.05),while PVRI and PAWP at 72 h,mPAP/mABP at 24-72 h were significantly decreased in experimental group (P ＜ 0.05).There were no significant differences in the values of oxygen metabolism between both groups (P ＞0.05).Conclusions LipoPGE1 can significantly decrease the pulmonary arterial pressure,which can enhance cardiac function and decrease the duration of intubation after surgery.