肺、体循环分别给药治疗体外循环后肺动脉高压危象的临床分析

目的 观察肺、体循环分别给药在治疗体外循环后严重肺动脉高压伴低心排综合征中的效果.方法 21例伴重度肺动脉高压的心脏病患者,在全麻体外循环下行心内直视手术.停体外循环时出现肺高压危象,经常规途径联合应用血管活性药物后无法脱离体外循环.在经肺动脉导管给予扩血管药物的同时,经主动脉根部置管输注去甲肾上腺素以对抗体循环低血压,以逐步脱机.结果 肺-体循环分别给药后,肺动脉压下降,桡动脉压逐渐上升,与给药前比较,差异有统计学意义;肺动脉压/桡动脉压比值以及肺循环阻力/体循环阻力比值降低,3 min后各时间点与用药前比较,差异有统计学意义.心脏指数逐渐上升,5 min后各时间点与0 min比较,差异有统计学意义.结论 肺一体循环分别输注酚妥拉明和去甲肾上腺素,可避免扩血管药物的体循环副作用,有助于体外循环后肺高压危象患者顺利脱机.

Combined infusion via pulmonary artery and aorta in the effective weaning from cardiopulmonary bypass

Objective To investigate the effects of delivering phentolamine via pulmonary artery combined with aortic infusion of norepinephrine in the treatment of patmnts with low cardiac output syndrome and refractory pulmonary hypertension.Methods Twenty-one open heart surgery patients who developed pulmonary hypertension crisis after removal of the cross-clamp. Routine therapy,including central venous influsion of vasodilator and/or inotropics,and inhaled NO,couldn't wean the patients from cardiopulmonary bvpass(CPB).Then they were treated with pulmonary arterial infusion of phentolamine and aortic infhsion to 0ptimized hemodynamies.If continuous infusion was anticipated,a Swan-Ganz catheter was advanced 35-40 cm through the femoral artery into aorta to substitute the aortic infusion.Hemodynamic data and the time to wean from CPB were recorded. Results All the patients were weaned from CPB successfully.The CPB time was 90±33(52-184)min,the aortic clamping time was 52±20(31-100)min.Three minutes after the administration of phentolamine and norepinephrine the pulmonary artery pressure,pulmonary vascular resistance index,and pulmonary-to-systemic vascular resistance ratio were significantly lower than those before the infusion(both P＜0.01).The systemic pressure and cardiac index significantly increased within 5 minutes after the infusion(both P＜0.01).Six patients underwent femoral arterial catheterization successfully,norepinephrine infusion continued until 12-18 h postoperatively. Nineteen patients survived and were discharged,one patient died of cardiac arrest three days postoperatively,and one died of pulmonary infection one week after surgery. Conclusion Combined through pulmonary artery infusion of Dhentolamine and aorta infusion of norepinephrine effectively control pulmonary hypertension crisis following CPB.