房水平单向活瓣式补片在手术治疗老年先心病合并重度肺动脉高压中的应用价值
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摘要
目的探讨房水平单向活瓣式补片在老年先天性心脏病(室间隔缺损)合并重度肺动脉高压病人手术中的应用效果。方法老年先天性心脏病(室间隔缺损)合并重度肺动脉高压病人62例。根据治疗方法的不同分为两组:对照组30例,采用药物保守治疗,观察组32例,采用房水平单向活瓣式补片行修补术。比较两组病人治疗前后的肺动脉压、动脉血气、心功能等指标变化。结果观察组治疗后的肺动脉压及肺动脉压/体动脉压值分别为(48.28±4.17)mm Hg和0.44±0.05,均显著低于对照组的(56.37±5.15)mm Hg和0.51±0.07(P<0.05)。观察组治疗后的Pa O2水平为(92.26±16.27)mm Hg,明显高于对照组的(80.18±18.31)mm Hg,Pa CO2、吸氧浓度分别为(29.06±2.15)mm Hg、(33.24±14.51)%,明显低于对照组的(31.86±1.85)mm Hg和(53.21±16.17)%(P<0.05)。观察组治疗后的右室收缩末期内径为(32.8±4.6)mm,低于对照组的(38.5±6.3)mm,6分钟步行距离为(202.2±40.9)m,长于对照组的(158.8±28.7)m(P<0.05)。结论老年先心病合并重度肺动脉高压病人在手术治疗中应用房水平单向活瓣式补片能够有效降低病人的肺动脉压,改善病人的心功能及肺功能,其临床疗效确切,安全性好。
Objective To investigate the effect of room horizontal one-way flap patch in treatment of elderly congenital heart disease( ventricular septal defect) with severe pulmonary hypertension.Methods 62 cases of elderly congenital heart disease( ventricular septal defect) patients with severe pulmonary hypertension treated in our hospital were selected as study subjects. According to the different treatment methods,they were divided into two groups: the control group( 30 cases) were treated with conservative drugs,and the observation group( 32 cases) were treated with atrial-level one-way flap repair surgery. Then compared the pulmonary arterial pressure,arterial blood gas,cardiac function and other indicators changes before and after treatment of two groups. Results The pulmonary artery pressure and pulmonary artery pressure/body arterial pressure after treatment in the observation group respectively were( 48. 28 ± 4. 17) mm Hg and 0. 44 ± 0. 05,which were significantly lower than those of the control group( 56. 37 ± 5. 15) mm Hg and 0. 51 ± 0. 07( P < 0. 05). The Pa O2 level of the observation group after treatment was( 92. 26 ± 16. 27) mm Hg,which was significantly higher than that of the control group( 80. 18 ±18. 31) mm Hg. The Pa CO2 and oxygen absorption concentrations respectively were( 29. 06 ± 2. 15) mm Hg and( 33. 24 ± 14. 51) %,which were significantly lower than( 31. 86 ± 1. 85) mm Hg and( 53. 21 ±16. 17) % in the control group( P < 0. 05). The right ventricular end-systolic diameter after treatment in the observation group was( 32. 8 ± 4. 6) mm,which was significantly lower than that of the control group( 38. 5 ± 6. 3) mm,and the 6-minute walking distance was( 202. 2 ± 40. 9) m,which was significantly longer than that of the control group( 158. 8 ± 28. 7) m( P < 0. 05). Conclusion The application of roomlevel one-way flap patch in elderly patients with congenital heart disease complicated with severe pulmonary hypertension can effectively reduce the pulmonary artery pressure and improve the patient's heart function and lung function. The clinical efficacy is good and the safety is good.
Objective To investigate the effect of room horizontal one-way flap patch in treatment of elderly congenital heart disease( ventricular septal defect) with severe pulmonary hypertension.Methods 62 cases of elderly congenital heart disease( ventricular septal defect) patients with severe pulmonary hypertension treated in our hospital were selected as study subjects. According to the different treatment methods,they were divided into two groups: the control group( 30 cases) were treated with conservative drugs,and the observation group( 32 cases) were treated with atrial-level one-way flap repair surgery. Then compared the pulmonary arterial pressure,arterial blood gas,cardiac function and other indicators changes before and after treatment of two groups. Results The pulmonary artery pressure and pulmonary artery pressure/body arterial pressure after treatment in the observation group respectively were( 48. 28 ± 4. 17) mm Hg and 0. 44 ± 0. 05,which were significantly lower than those of the control group( 56. 37 ± 5. 15) mm Hg and 0. 51 ± 0. 07( P < 0. 05). The Pa O2 level of the observation group after treatment was( 92. 26 ± 16. 27) mm Hg,which was significantly higher than that of the control group( 80. 18 ±18. 31) mm Hg. The Pa CO2 and oxygen absorption concentrations respectively were( 29. 06 ± 2. 15) mm Hg and( 33. 24 ± 14. 51) %,which were significantly lower than( 31. 86 ± 1. 85) mm Hg and( 53. 21 ±16. 17) % in the control group( P < 0. 05). The right ventricular end-systolic diameter after treatment in the observation group was( 32. 8 ± 4. 6) mm,which was significantly lower than that of the control group( 38. 5 ± 6. 3) mm,and the 6-minute walking distance was( 202. 2 ± 40. 9) m,which was significantly longer than that of the control group( 158. 8 ± 28. 7) m( P < 0. 05). Conclusion The application of roomlevel one-way flap patch in elderly patients with congenital heart disease complicated with severe pulmonary hypertension can effectively reduce the pulmonary artery pressure and improve the patient's heart function and lung function. The clinical efficacy is good and the safety is good.
引文
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[6]洪萍,于亚梅,周霖,等.尿酸水平与先天性心脏病相关性肺动脉高压相关性研究[J].临床军医杂志,2018,46(2):163-165.
[7]符洪犊,张亮,白树堂.单向活瓣治疗合并重度肺动脉高压先天性心脏病的临床应用[J].重庆医学,2014,43(23):3085-3087.
[8]Josanna L.Pulmonary Hypertension in Adult Congenital Heart Disease[J].Curr Treat Options Cardiovasc Med,2014,16(8):328.
[9]Annelieke M,Mark S,Irene D,et al.Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification[J].Int J Cardiol,2014,174(2):299-305.
[10]赁可.当代先天性心脏病的诊治——绝不仅是理论和技巧[J].临床外科杂志,2017,25(5):325-326.
[11]杨迪成,庄瑜,袁忠祥.风湿性二尖瓣病变合并重度肺高压370例外科治疗[J].临床外科杂志,2016,24(3):213-215.
[2]朱桂敏,马士红,李秀娟,等.实时三维超声心动图评价房间隔缺损合并肺动脉高压手术前后右室功能的研究[J].临床超声医学杂志,2018,20(2):73-76.
[3]周翔辉.瓣膜手术治疗心脏瓣膜病合并肺动脉高压的临床效果[J].当代临床医刊,2018,31(1):3652-3653.
[4]Robert T,Kostas D,Robin C,et al.Management of Adults With Congenital Heart Disease and Pulmonary Arterial Hypertension in the UK:Survey of Current Practice,Unmet Needs and Expert Commentary[J].Heart Lung Circ,2017.
[5]房大广,崔春燕,冯增斌,等.米力农对肺动脉高压的治疗作用及其机制探究[J].东南大学学报(医学版),2018,37(1):83-86.
[6]洪萍,于亚梅,周霖,等.尿酸水平与先天性心脏病相关性肺动脉高压相关性研究[J].临床军医杂志,2018,46(2):163-165.
[7]符洪犊,张亮,白树堂.单向活瓣治疗合并重度肺动脉高压先天性心脏病的临床应用[J].重庆医学,2014,43(23):3085-3087.
[8]Josanna L.Pulmonary Hypertension in Adult Congenital Heart Disease[J].Curr Treat Options Cardiovasc Med,2014,16(8):328.
[9]Annelieke M,Mark S,Irene D,et al.Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification[J].Int J Cardiol,2014,174(2):299-305.
[10]赁可.当代先天性心脏病的诊治——绝不仅是理论和技巧[J].临床外科杂志,2017,25(5):325-326.
[11]杨迪成,庄瑜,袁忠祥.风湿性二尖瓣病变合并重度肺高压370例外科治疗[J].临床外科杂志,2016,24(3):213-215.