肺动脉高压心脏手术后危象多因素分析

目的探讨肺动脉高压（pulmonary arterial hypertension，PAH）左向右分流型先天性心脏病（left-to-right shunt congenital heart diseases，L-RCHD）影响心脏手术术后肺高压危象的重要因素。方法对229例心脏手术同时合并肺动脉高压患者的可能导致术后肺高压危象的影响因素进行回顾性分析。结果术后肺高压危象26例次，死亡6例，死亡率为23．08％。术前呼吸道感染、术前吸氧、术前卡托普利、手术时间、通气频率、再次插管和术后一氧化氮（nitrogen monoxidum，NO）治疗对肺动脉高压患者术后出现肺高压危象的影响差异有统计学意义（P〈0．05）。术前呼吸道感染、手术时间和再次插管为危险因素；术前吸氧、术前卡托普利、通气频率和术后NO治疗为保护因素。结论术前呼吸道感染、手术时间和再次插管为肺动脉高压患者心脏外科手术术后肺高压危象的危险因素；术前吸氧、术前卡托普利、通气频率和术后NO治疗为保护因素。

Multivariate Analysis of Pulmonary Hypertensive Crisis after Cardiac Surgery in Patients with Congestive Pulmonary Arterial Hypertension

Objective To investigate the risk factors that influence the morbidity of pulmonary hypertensive crisis（PHC） after surgical treatment in left-to-right shunt congenital heart diseases（L-RCHD） patients with congestive pulmonary arterial hypertension （PAH）. Methods 229 cases of L-RCHD with congestive PAH who underwent surgical treatment were eligible for entry into the study. The influence factors were analyzed retrospectively. Results There were 26 cases of PHC, six died, the mortality was 23.08%. Effects of preoperative respiratory infection, supplemental oxygen and administration of captopril ,operational time ,frequency of ventilation, repeated intubalion and the postoperative NO had statistically significant on the morbidity of PHC in L- RCHD with congestive PAH after surgical treatment （ P 〈 0.05 ）. Conclusion Preoperative respiratory infection, operational time and repeated intubation are risk factors, while preoperative supplemental oxygen, the preoperative use of eaptopril, frequency of ventilation and the postoperative use of NO are protective factors, for PHC in L-RCHD with congestive PAH after surgical treatment.