室间隔缺损合并重度肺动脉高压围手术期处理

目的 :评估室间隔缺损合并重度肺动脉高压手术治疗围手术期处理的效果。方法 :选择 5 5例室间隔缺损合并重度肺动脉高压病例 ,在手术时放置Swan ganz导管 ,术后进行肺动脉压监测 ;2 0例用单向活瓣补片修补室缺 ,术后用超声心动图监测分流情况 ;用镇静 ,肌松 ,过度通气 ,血管扩张剂等治疗肺动脉高压危象。结果 :发现 7例持续肺动脉高压 ,死亡 2例 ;2 7例有肺动脉高压危象 ,死亡 2例 ;在严重肺动脉高压时 ,单向活瓣补片有右向左分流 ,肺动脉压下降后分流停止 ,未发现左向右分流。结论 :室间隔缺损合并重度肺动脉高压应把握好手术适应症 ,有不可逆的肺动脉高压患者禁止手术 ;Swan ganz导管在术后肺动脉高压处理上有重要作用 ;单向活瓣补片修补室缺能在术后发生重度肺动脉高压时发挥良好的右向左单向分流作用 ,肺动脉压下降后又能自动关闭。

Perioperative treatment for ventricular septal defect complicated with severe pulmonary hypertention

Objective:To evaluate the outcome of perioperative treatment for ventricular septal defect complicated with severe pulmonary hypertention.Method:During operations,fifty five VSD cases were inserted Swan\|ganz catheter into pulmonary artery in order to monitor pulmonary pressure immediately after operation.Twenty cases of VSD were repaired with unidirectional patch.UCG were used to monitor the shunt penetrating the patch.Treating pulmonary hypertensive crises by sedating,paralyzing,hyperventilation,pulmonary vascular dilation.Result:7 cases founded to be irreversible pulmonary hypertention,2 died.In 27 cases,pulmonary hypertensive crises were monitored,2died.Right\|to\|left shuntings were founded penetrating unldirectional patchs when severe pulmonary hypertention occurred,the shunts disappeared spontaneously;When pulmonary pressure lowered,no left\|to right shunt was founded.Conclusion:VSD with irreversible pulmonary hypertension is not suitable for repair;Swan\|ganz duct plays an improtant role in the treatment for postoperative pulmonary hypertension;Sedating,paralyzing,hyperventilation,pulmonary vascular dilation are the fundmental measures for the treatment of postoperative pulmonary hypertension.Unidirectional patch shunt blood to left ventricle from right ventricle while severe pulmonary hypertension occurs.The shunt disappear when pulmonary pressure lower.o blood penetrate unidirectional patch no matter pulmonary pressure is high or low.