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。

Analysis of perioperative hypoxemia in mitral valve disease complicated with pulmonary hypertension

Objective To review the treatment methods for perioperative hypoxemia in the patients with mitral valve disease complicated with pulmonary hypertension.Methods Seventy-six mitral valve disease and pulmonary hypertension patients with low cardiac output and hypoxemia in the perioperative period were treated with mechanical ventilation and nitroglycerin： 0.5-1.0 μg/（kg·min） continuous infusion,milrinone 0.3-0.7 μg/（kg·min） infusion.Results Three patients died due to severe hypoxemia and heart failure between the 7th and 10th day after surgery.The remaining patients were discharged with grade Ⅱ or Ⅲ cardiac function.Patients were followed up from 5 months to 5 years.The results showed that there were 17 patients with gradeⅠcardiac function and 58 patients with gradeⅡ.One patient died of cerebral hemorrhage after 3 years,who received bioprosthetic valve implantation,which was complicated by hypertension.Conclusion Patients with mitral valve disease and pulmonary hypertension are prone to have perioperative hypoxemia.Severe hypoxemia can be corrected by improving pulmonary artery pressure and pulmonary expansion by means of drugs supporting cardiac function and mechanic ventilation.Pumped effective doses of nitroglycerin,milrinone and other doses are effective to reduce pulmonary artery pressure and improve hypoxemia.