室间隔缺损并重度肺动脉高压外科疗效的多因素分析

目的:总结室间隔缺损(VSD)合并重度肺动脉高压(PH)的外科治疗疗效及其影响因素。方法:回顾性分析和随访62例VSD伴重度PH患者的诊治和预后情况,并对多种影响因素进行t检验及多元线性回归分析。结果:本组住院死亡6例,占9.6％;随访8个月～7年,1、3、5年生存率分别为96.4％、91.1％、80.4％;对多种相关因素进行t检验及多元线性回归分析,提示年龄,VSD的大小、位置,肺/体平均动脉压比值(Pp/Ps)>0.95与否,心功能,术后6个月肺动脉压/手术前肺动脉压>0.75与否,围术期综合性降肺动脉压处理,手术后定期应用前列腺素E1(PGE1)等与生存期有明显相关性。结论:明确VSD的位置,围术期综合性降肺动脉压处理不仅对选择手术时机有指导意义,而且可以降低手术死亡率,手术后定期应用PGE1可提高生存率。

Analysis of surgical results and the correlated factors affecting prognosis in patients with ventricular septal defect associated with pulmonary hypertension

Objective: This retrospective study was conducted to evaluate the result of surgical treatment of ventricular septal defect (VSD) associated with pulmonary hypertension (PH) and to explore the correlated factors affecting the prognosis. Methods:Sixty-two patients with VSD complicated with PH underwent surgical repair under extracorporeal circulation from October 1993 to april 1999. Its diagnosis was made by echocardiogram. Membranous defect was present in 41 patients, muscular defect in 4 patients, supracristal defect in 13 patients and undercristal defect in 2 patients. The Pp/Ps was >0. 75 (0. 75-0. 98). Results.- The hospital mortality rate was 9. 6%. The causes of death was respiration failure, the Pp/Ps of dead patients exceeded 0. 95 in perioperation. In follow up of 8 months to 7 years, the 1,3, 5-year survival rates were 96. 4%, 91- 1% and 80. 4% respectively. The correlated factors affecting the prognosis were age, size and location of VSD, Pp/PsX). 95, heart function, pulmonary pressure at 6 month after operation/pulmonary pressure before operation, perioperative synthetically treatment of PH and postoperatively treatment with prostaglandin El (PGE1) by t test and multiple linear regression method. Conclusion; Definiting position of VSD, perioperative synthetically treatmenting PH not only possesses conductive value to choose operative chance but may reduce operative mortality.lt enhanced survival rate that periodical treatment with prostaglandin El (PGE1) postoperatively.