风湿性二尖瓣狭窄合并重度肺动脉高压患者围术期护理体会

目的：总结11例术前心脏彩超提示为风湿性心脏病,二尖瓣狭窄伴或不伴关闭不全合并重度肺动脉高压患者的围术期护理体会。方法：本组患者术前均给予小剂量枸橼酸西地那非控制肺动脉压力,并予强心利尿,改善通气功能,纠正内环境紊乱。所有患者均在中度低温体外循环下实施二尖瓣置换术。术后早期经漂浮导管严密监测肺动脉压力,持续镇静, FiO2维持于50-80%,轻度过度通气,维持呼吸末正压5-7cmH2O。所有患者早期均给予枸橼酸西地那非,对于肺动脉平均压/主动脉平均压>0.5者雾化吸入伊洛前列素。结果：术前复查心脏彩超提示肺动脉压力较入院时有一定程度降低。手术均顺利,术后并发肺动脉高压危象4例,经上述处理效果良好,低心排综合征并予心脏机械辅助(IABP)1例,快速心房纤维颤动7例。术后正性肌力药物平均使用7?2.3天,呼吸机辅助22?9.6天,所有患者经积极治疗和护理均治愈出院。结论：风湿性二尖瓣病变合并重度肺动脉高压患者围术期常并发肺高压危象而严重影响预后,此类患者在治疗及护理的多个环节采取综合措施控制肺动脉压力,预防肺高压危象,从而提高手术疗效。     

风湿性心脏病合并重度肺动脉高压患者二尖瓣置换术后护理

回顾性总结2004年10月-2005年10月56例风心病合并重度肺动脉高压行二尖瓣置换术患者的术后护理方法。对本组术后患者持续动态监测肺动脉压的变化,加强呼吸道管理和心功能的维护,保证充分供氧,遵医嘱给予镇痛镇静药物,并且做好药物应用护理,预防肺动脉高压危象。认为对术后患者持续动态监测肺动脉压的变化,控制肺动脉高压和预防肺动脉高压危象对提高风心病合并重度肺动脉高压患者的手术成功率起重要作用。     

凋亡机制在风湿性心脏病二尖瓣狭窄肺动脉高压形成中的作用

目的：研究凋亡机制在风湿性心脏病单纯二尖瓣狭窄（RHDMS）所致肺动脉高压（PH）形成机制中的作用。方法：应用免疫组化及原位缺口末端DNA标记技术检测风湿性心脏病二尖瓣狭窄重度肺动脉高压者肺动脉活检标本，检测肺动脉血管壁细胞的增殖、凋亡情况。用免疫组化技术检测凋亡相关基因bcl-2和bax的表达。结果：RHD患者肺动脉的结构发生明显改建，RHD及对照组肺动脉内都有增殖与凋亡的细胞，但RHD组增殖细胞多而凋亡细胞明显减少。bcb2在RHD组中表达强度明显高于对照组，而bax在对照组中的表达高于RHD组。结论：在肺血淤滞、缺氧等因素作用下，bcl-2和bax两种基因表达比例发生变化，使肺动脉壁细胞凋亡减少，造成细胞堆积，参与引起肺血管结构改建，从而参与导致肺动脉高压。     

风湿性左房室瓣狭窄合并重度肺动脉高压患者的护理

风湿性病变是我国左房室瓣狭窄最常见的病因,由于瓣叶结构一般毁损较严重常需实施瓣膜置换手术。由于长时间肺静脉淤血,患者随病程迁延常合并不同程度的肺动脉高压,严重影响患者右心功能及全身氧合状况。左房室瓣置换术后患者肺动脉压力多可     

重度二尖瓣狭窄患者行瓣膜置换手术的麻醉处理

重度二尖瓣狭窄患者病程长,病情重,术前心功能差,且多伴有肺动脉高压,麻醉处理难度大,风险高.本院自2000～2003年成功为7例重度二尖瓣狭窄患者在体外循环下施行二尖瓣置换,现将麻醉处理报告如下.     

风湿性心脏病二尖瓣狭窄闭式扩张术治疗现状

1概述风湿性心脏病是临床上的常见病、多发病,占心脏病住院病人的40%,而风湿性心脏病中二尖瓣受损占70%~80%[1]。1982年统计上海地区13032例风湿性心脏病,有10257例累及二尖瓣瓣膜,占78.7%。可见风湿性心脏病二尖瓣病变的高发率,它也是危及生命的高危因素,在20世纪40年代以前只     

风湿性心脏瓣膜病合并肺动脉高压术后护理

肺动脉高压(PH)是风湿性心脏病(风心病)患者常见的严重并发症之一.风心病合并PH患者在行瓣膜置换术治疗时,常由于PH而导致术后心、肺功能衰竭,而体外循环(CPB)中缺血和再灌注损伤更加重了肺动脉高压及导致心肌损伤.     

风湿性心脏瓣膜病合并肺动脉高压术后护理

肺动脉高压（PH）是风湿性心脏病（风心病）患者常见的严重并发症之一。风心病合并PH患者在行瓣膜置换术治疗时,常由于PH而导致术后心、肺功能衰竭,而体外循环（CPB）中缺血和再灌注损伤更加重了肺动脉高压及导致心肌损伤。瓣膜置换术是治疗此类患者的有效手段,但因此类患者大多病史较长,其肺血管组织结构发生异常,术后肺动脉高压往往持续存在。     

风湿性二尖瓣狭窄小左心室病人的术后并发症护理

正风湿性二尖瓣狭窄(mitral stenosis,MS)是最常见的心脏瓣膜病变之一,其病程长,可达数年至数十年,容易出现左心室结构和功能改变,部分病人可发展为小左心室或左室萎缩,病程愈长小左心室发生率愈高。小左心室病人常合并有三尖瓣关闭不全、左心房血栓和肺动脉高压等,瓣膜置换是治疗二尖瓣重度狭窄的有效方法[1],但其术后并发症多,术后监护和护理要求特殊,对护理工作提出了很高的要求。我院2002年7月—2012年7月收治40例风湿性二尖瓣狭窄小左心室病人,在其术后并     

风湿性二尖瓣狭窄并左房巨大血栓误诊1例

风湿性二尖瓣狭窄并左房巨大血栓误诊１例焦志俭巴彦县人民医院１５１８００１病历摘要患者男性，４３岁。９个月前患过“肺炎”，以后反复出现咳嗽，咳少许白粘痰，偶带血丝，伴心悸、气短。当地医院拟诊为“风湿性心脏病”。一个月前出现声嘶，伴周身浮肿，服用地高辛、...     

经皮二尖瓣球囊成形术在二尖瓣狭窄伴重度心力衰竭时的应用

介绍二尖瓣狭窄伴重度心力衰竭（心衰）患者实施经皮二尖瓣球囊成形术（PBMV）的结果和初步体会。9例患者中男6例，女3例，年龄24～52岁，全部患者心功能均为Ⅳ级（按NYHA分级），术前抗心衰药物治疗效果极不理想。经施行PBMV后，血流动力学明显得已改善：左房平均压由术前4．34±1．02kPa（1kPa=7．5mmHg）降至术后1．64±0．82kPa，二尖瓣跨瓣压差由术前3．26±0．84kPa降至术后0．72±0．56kPa；瓣口面积由术前0．78±0．30cm~2增至术后2．11±0．24cm~2，左房内径术后较术前缩小了约10mm（P值均＜0．001）；在短期内心功能迅速恢复至Ⅰ～Ⅱ级，运动耐量明显增加，心衰症状缓解率达100％。作者认为：二尖瓣狭窄伴重度心衰时，只要排除了加重心衰的其他原因，应尽早施行PBMV，PBMV是一种安全、可靠和行之有效的治疗方法。作者同时对PBMV时球囊方式选择及并发症的防治进行了讨论。     

Comparison of pulmonary venous flow velocities and left ventricular diastolic and ejection time in patients with moderate mitral and aortic stenosis. Pulmonary venous flow velocities in mitral and aortic stenosis

Background: Doppler pulmonary venous flow velocities (PVFV) pattern are useful parameters in assessing the left ventricular diastolic functions. Both mitral stenosis (MS) and aortic stenosis (AS) lead to diastolic dysfunction. We compared PVFV and left ventricular diastolic and ejection time (ET) in patients with moderate MS and AS. Methods: Forty-three patients with moderate MS (group 1), 65 patients with moderate AS (group 2), and 33 healthy subjects as controls (group 3) were included in this study. After obtaining standard measurements echocardiographically, diastolic period (DP), ET, the ratio of the DP to the ET (DP/ET), isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), peak systolic flow velocity (PS), peak antegrade diastolic flow velocity (PD), peak reversal flow velocity at atrial contraction (PRA), the ratio of the peak systolic to the diastolic flow velocity (PS/PD), deceleration time of the antegrade diastolic flow (PDDT), and pressure half time of the peak antegrade diastolic flow velocity (PDPHT) were measured. Mitral valve area (MVA), aortic valve area (AVA), systolic pulmonary artery pressure (PAP), peak and mean gradients were calculated with standard formulas. Results: In univariate analysis, MVA was correlated with PDPHT and PDDT (r = –0.41; p < 0.01, r = –0.36; p < 0.05, respectively), also it was correlated with DP/ET (r = –0.57; p < 0.001). Mitral peak and mean diastolic gradient were correlated with PS/PD (r = –0.43; p < 0.01, r = –0.36; p < 0.05, respectively) and DP/ET (r = 0.51; p < 0.01, r = 0.46; p < 0.01, respectively). AVA was only correlated with DP/ET (r = 0.38; p < 0.05). Aortic peak and mean systolic gradient were correlated with PS/PD (r = –0.29; p < 0.05, r = –0.27; p < 0.05, respectively) and DP/ET (r = –0.38; p < 0.01, r = –0.40; p < 0.01, respectively). In the same analysis, PAP in patients in group 1 and 2 was correlated with PS/PD (r = –0.42; p < 0.01 and r = –0.40; p < 0.01, respectively) and also it was correlated with PD (r = 0.37; p < 0.05 and r = 0.27; p < 0.05, respectively) in both groups. Conclusion: Moderate MS and AS similarly affect the PVFV, and PS/PD correlates with hemodynamics similarly both in MS and AS. Nevertheless, PDDT and PDPHT correlate with solely MVA. IRT higher in AS than MS, though DP/ET and ICT higher in MS than AS, and DP/ET relates with the severity of both MS and AS.     

经皮二尖瓣球囊成形术治疗伴重度钙化二尖瓣狭窄33例观察及护理

目的 :观察风湿性心脏病 (RHD)伴重度钙化的二尖瓣狭窄 (MS)患者行经皮二尖瓣球囊成形术 (PBMV)的近期疗效及安全性。方法 :对 33例伴重度钙化的MS患者行逐步球囊扩张法PBMV治疗 ,术中监测左房平均压等 ,术前、术后 3个月进行心脏超声心动图检查 ,并对结果进行统计分析。结果 :术后左房压、二尖瓣跨瓣压差显著下降 ;超声心动图示二尖瓣口面积显著扩大 ,心功能显著改善 ,左房内径、二尖瓣跨瓣压差、肺动脉收缩压显著减小 ,左室内径无显著变化。结论 :逐步扩张法PBMV治疗伴重度钙化的MS是一种安全、有效的方法     

风湿性瓣膜病变合并肺动脉高压87例观察

目的:总结87例风湿性瓣膜病变合并肺动脉高压患者行手术治疗的围术期处理经验。方法:87例风湿性瓣膜病变合并肺动脉高压患者行二尖瓣置换75例,二尖瓣置换 主动脉瓣置换12例。结果:此组患者手术过程顺利,术后并发低心输出量综合征5例,严重心律失常9例,早期死亡2例,病死率2.3%,其中低心排1例,1例因多脏器功能衰竭死亡。结论:风湿性瓣膜病变合并肺动脉高压患者病情较重,注意围术期各环节处理,即重视术前心功能改善,术中加强心肌保护,合理纠正病变,术后严密监护,可提高手术成功率。     

The hemodynamic effects of severe mitral stenosis and pulmonary hypertension during labor and delivery

Pregnancy represents a hyperdynamic state characterized by increased cardiac output, blood volume, and oxygen consumption. Valvular heart disease may blunt this response and, especially when associated with pulmonary hypertension, carries a high mortality. We report the hemodynamic variables as measured through the completion of labor, delivery and postpartum period in a woman with severe mitral stenosis and pulmonary hypertension.The opinions or assertions contained here in are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense     

室间隔缺损并肺动脉高压59例外科治疗

目的总结室间隔缺损合并肺动脉高压病例的诊断及外科治疗方法。方法回顾分析本院近年来所收治的59例室间隔缺损合并肺动脉高压患儿，其中单纯室间隔缺损（VSD）46例，VSD合并房间隔缺损（ASD）6例，VSD合并动脉导管未闭（PDA）7例。59例均行手术治疗。结果57例治愈，死亡2例。其中1例死于术后低心排血量综合征，1例死于严重肺部感染导致的多脏器功能衰竭。死亡率3．38％。结论室缺患儿一旦合并有肺动脉高压应尽早手术治疗，合适的治疗方法是手术成功的关键。     

Percutaneous mitral balloon valvuloplasty reduces mean platelet volume in patients with rheumatic mitral stenosis

Abstract

Background. Rheumatic mitral stenosis (RMS) is associated with increased thromboembolic event, especially in the presence of concomitant atrial fibrillation. In addition, increased platelet activity including elevated mean platelet volume (MPV) has been demonstrated in patients with RMS. It has also been reported that percutaneous mitral balloon valvuloplasty (PMBV) attenuates platelet activity. However, the impact of PMBV on MPV has never been studied. Accordingly, we aimed to investigate whether PMBV decreases MPV in patients with RMS. Methods. In the present study, MPV was measured in 20 patients with RMS planned for PMBV just before and 1 month after the procedure. Twenty sex- and age- matched apparently healthy controls were used for comparison. Mitral valve area (MVA), transmitral gradient (TMG) and pulmonary artery pressure (PAP) were measured using transthoracic echocardiography. Results. As compared to apparently healthy controls, patients with RMS had higher MPV (9.05?±?1.26 vs. 7.56?±?0.74 fl, p <?0.001). All patients with RMS underwent successful PMBV. One month after the procedure, MVA, TMG and PAP were reduced significantly (p <?0.0001). As compared to values obtained before the procedure, white blood cell count, hemoglobin concentration and hematocrit remained unchanged. However, 1 month after the procedure platelet count had increased (p <?0.05) and MPV decreased significantly (to 7.78?±?0.59, p <?0.0001). PMBV induced an absolute decrease in MPV more than 0.2 fl in 19 of 20 patients (95%). Conclusions. As compared to apparently healthy controls, patients with RMS have higher MPV reflecting increased platelet activity, and PMBV is associated with a significant decrease in MPV 1 month after the procedure.     

二尖瓣病变并肺动脉高压围术期低氧血症分析

目的总结二尖瓣病变并肺动脉高压患者围术期低氧血症的治疗方法。方法选择二尖瓣病变并肺动脉高压围术期发生低氧血症、低心排血量患者76例,给予呼吸机辅助呼吸、硝酸甘油0.5~1.0μg/（kg.min）持续泵入、米力农0.3~0.7μg/（kg.min）泵入。结果死亡3例,均因严重低氧血症、心衰,经治疗低氧血症等无改善,于术后7~10 d因继发多器官功能衰竭死亡;其余患者经治疗后好转出院,心功能Ⅱ、Ⅲ级。随访5月~5年,心功能Ⅰ级17例、Ⅱ级58例,术后3年死亡1例,该患者因置入生物瓣合并高血压死于脑出血。结论二尖瓣病变并肺动脉高压患者围术期易发生低氧血症,严重的低氧血症可通过扩张肺动脉降低肺动脉压并配合心功能支持药物及呼吸机治疗矫正。硝酸甘油、米力农等有效剂量泵入是降低肺动脉压改善低氧血症的有效方法。     

白介素-6和内皮素-1在慢性阻塞性肺疾病合并肺动脉高压患者中的表达

目的:研究白介素-6(IL-6)和内皮素-1 (ET-1)在慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者和COPD无PH患者中的表达水平.方法:66例COPD合并PH患者和64例COPD无PH患者,检测IL-6和ET-1水平,心脏多普勒检测肺动脉收缩压力(PASP),PASP≥36 mmHg为PH,检查肺功能、动脉血气、6 min步行距离.结果:COPD合并PH患者IL-6和ET-1水平高于COPD无PH患者,分别是中位数3.6 pg/L(四分位间距2.3 ～ 4.9 pg/L)与中位数2.3 pg/L(四分位间距1.2 ～ 3.7 pg/L),差异有统计学意义(z=-2.756,P＜0.01);中位数4.7 pg/L(四分位间距,1.8 ～ 7.9 pg/L)与中位数1.5 pg/L(四分位间距,0.9～3.7 pg/L),差异有统计学意义(z=-2.945,P＜0.01).所有患者IL-6和ET-1水平呈正相关(r=0.782,P=0.001);肺动脉压力水平与IL-6(r=0.381,P=0.001)和ET-1(r=0.529,P=0.001)水平有关;6 min步行距离分别和氧分压负相关(r=-0.728,P=0.032),和ET-1正相关(r=0.625,P=0.001),和IL-6正相关(r=0.461,P=0.001).结论:IL-6和ET-1可能与COPD并PH形成有关,具体机制有待进一步研究.