房水平单向活瓣式补片对老年先天性心脏病合并重度肺动脉高压的临床效果分析
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摘要
目的:探究房水平单向活瓣式补片对老年先天性心脏病伴重度肺动脉高压患者的作用疗效。方法:选取我院心血管科收治的先天性心脏病伴重度肺动脉高压患者80例,随机分为对照组和实验组。对照组40例,予以常规基础药物治疗(波生坦);实验组,在基础药物治疗两个疗程后,采用房水平单向活瓣式补片进行手术治疗。比较两组患者治疗前后的肺动脉压(PAP)、体动脉压(SAP)、肺动脉压/体动脉压(PAP/SAP)、动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)及吸氧浓度、右室收缩末期内径变化情况。结果:治疗后,与对照组比较,实验组肺动脉压下降幅度较大(P<0.05);与治疗前比较,实验组肺动脉压与体动脉压的比值显著下降,且优于对照组(P<0.05);治疗后,实验组动脉血氧分压、二氧化碳分压以及吸氧浓度显著优于对照组(P<0.05);治疗后,实验组患者右室收缩末期内径显著小于对照组(P<0.05);随访结果:实验组死亡1例、术后活瓣坏死2例、其余37例病情均转好且无复发情况;对照组死亡4例、出现各项并发症16例、剩余20例病情转好。结论:房水平单向活瓣式补片法可有效改善患者的肺动脉压、体动脉压、动脉血氧分压、二氧化碳分压及吸氧浓度、右室收缩末期内径及6 min步行距离,对老年先天性心脏病伴重度肺动脉高压患者疗效显著。
Objective: To investigate the clinical analysis of real level of unidirectional valve patch of congenital heart disease with severe pulmonary hypertension in elderly patients. Methods: 80 patients with congenital heart disease with severe pulmonary hypertension from our hospital were selected and randomly divided into control group and experimental group. The control group, 40 cases with medications on a regular basis(temple), one month before the 70.25 mg. Po. The bid, and then to 125 mg. Po. The bid, all round for a period of treatment, medication two period of treatment; The experimental group, in basic drugs after 2 courses of treatment, living room level uni-directional disc type patch for surgery. Compare two groups of patients before and after treatment of pulmonary artery pressure(PAP), arterial pressure(SAP), pulmonary artery pressure/body arterial pressure(PAP/SAP), arterial blood oxygen partial pressure(Pa O2), CO2 partial pressure(Pa CO2) and oxygen concentration, changes in right ventricular end systolic diameter and 6 min walking experiment comparison; Follow-up after treatment. Results:(1) after treatment, the experimental group, pulmonary artery pressure drop significantly greater than the control group, the difference was statistically significant(P<0.05); The experimental group pulmonary artery pressure and the ratio of arterial pressure dropped significantly, and better than the control group(P<0.05); after treatment, the experimental group arterial blood oxygen partial pressure, CO2 partial pressure and oxygen concentration significantly better than control group(P <0.05); after treatment, the experimental group patients with right ventricular end systolic diameter was significantly less than the control group, the difference was statistically significant(P<0.05); follow-up results from the study: death in 1 case, postoperative flap necrosis in2 cases, the rest of the 37 cases of the disease are better and no recurrence; Control group died 4 cases, 16 cases appeared various complications, the remaining 20 cases of illness. Conclusion: Room level one-way flapper type patch method can effectively improve, arterial pressure, pulmonary artery pressure in patients with arterial blood oxygen partial pressure, concentration of carbon dioxide and oxygen partial pressure, right ventricular end systolic diameter and 6 min walking distance, the congenital heart disease for the elderly patients with severe pulmonary hypertension with curative effect is remarkable.
Objective: To investigate the clinical analysis of real level of unidirectional valve patch of congenital heart disease with severe pulmonary hypertension in elderly patients. Methods: 80 patients with congenital heart disease with severe pulmonary hypertension from our hospital were selected and randomly divided into control group and experimental group. The control group, 40 cases with medications on a regular basis(temple), one month before the 70.25 mg. Po. The bid, and then to 125 mg. Po. The bid, all round for a period of treatment, medication two period of treatment; The experimental group, in basic drugs after 2 courses of treatment, living room level uni-directional disc type patch for surgery. Compare two groups of patients before and after treatment of pulmonary artery pressure(PAP), arterial pressure(SAP), pulmonary artery pressure/body arterial pressure(PAP/SAP), arterial blood oxygen partial pressure(Pa O2), CO2 partial pressure(Pa CO2) and oxygen concentration, changes in right ventricular end systolic diameter and 6 min walking experiment comparison; Follow-up after treatment. Results:(1) after treatment, the experimental group, pulmonary artery pressure drop significantly greater than the control group, the difference was statistically significant(P<0.05); The experimental group pulmonary artery pressure and the ratio of arterial pressure dropped significantly, and better than the control group(P<0.05); after treatment, the experimental group arterial blood oxygen partial pressure, CO2 partial pressure and oxygen concentration significantly better than control group(P <0.05); after treatment, the experimental group patients with right ventricular end systolic diameter was significantly less than the control group, the difference was statistically significant(P<0.05); follow-up results from the study: death in 1 case, postoperative flap necrosis in2 cases, the rest of the 37 cases of the disease are better and no recurrence; Control group died 4 cases, 16 cases appeared various complications, the remaining 20 cases of illness. Conclusion: Room level one-way flapper type patch method can effectively improve, arterial pressure, pulmonary artery pressure in patients with arterial blood oxygen partial pressure, concentration of carbon dioxide and oxygen partial pressure, right ventricular end systolic diameter and 6 min walking distance, the congenital heart disease for the elderly patients with severe pulmonary hypertension with curative effect is remarkable.
引文
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[13]Blonde-Cynober F,Morineau G,Estrugo B,et al.Diagnostic and prognostic value of brain natriuretic peptide(BNP)concentrations in very elderly heart disease patients:Specific geriatric cut-off and impacts of age,gender,renal dysfunction,and nutritional status[J].Archives of gerontology and geriatrics,2011,52(1):106-110
[14]Wannamethee S G,Shaper A G,Whincup P H,et al.Obesity and risk of incident heart failure in older men with and without pre-existing coronary heart disease:does leptin have a role?[J].Journal of the American College of Cardiology,2011,58(18):1870-1877
[15]Joynt K E,Orav E J,Jha A K.The association between hospital volume and processes,outcomes,and costs of care for congestive heart failure[J].Annals of internal medicine,2011,154(2):94-102
[16]Murad K,Kitzman D W.Frailty and multiple comorbidities in the elderly patient with heart failure:implications for management[J].Heart failure reviews,2012,17(4-5):581-588
[2]Akagi T.Catheter intervention for adult patients with congenital heart disease[J].Journal of cardiology,2012,60(3):151-159
[3]Iung B,Vahanian A.Epidemiology of valvular heart disease in the adult[J].Nature Reviews Cardiology,2011,8(3):162-172
[4]Takken T,Giardini A,Reybrouck T,et al.Recommendations for physical activity,recreation sport,and exercise training in pae diatric patients with congenital heart disease:a report from the Exercise,Basic&Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation,the European Congenital Heart and Lung Exercise Group,and the Association for European Paediatric Cardiology[J].European journal of preventive cardiology,2012,19(5):1034-1065
[5]Tay E L W,Peset A,Papaphylactou M,et al.Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome[J].International journal of cardiology,2011,151(3):307-312
[6]Oerkild B,Frederiksen M,Hansen J F,et al.Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease:results from a randomised clinical trial[J].Age and ageing,2011,40(1):78-85
[7]Brown J M,Stewart J C,Stump T E,et al.Risk of coronary heart disease events over 15 years among older adults with depressive symptoms[J].The American Journal of Geriatric Psychiatry,2011,19(8):721-729
[8]Saunders J T,Nambi V,de Lemos J A,et al.Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease,heart failure,and mortality in the Atherosclerosis Risk in Communities Study[J].Circulation,2011,123(13):1367-1376
[9]Drazner M H.The progression of hypertensive heart disease[J].Circulation,2011,123(3):327-334
[10]Ussia G P,Barbanti M,Colombo A,et al.Impact of coronary artery disease in elderly patients undergoing transcatheter aortic valve implantation:insight from the Italian Core Valve Registry[J].International journal of cardiology,2013,167(3):943-950
[11]Weiss C O.Frailty and chronic diseases in older adults[J].Clinics in geriatric medicine,2011,27(1):39-52
[12]Sheer A J,Heckman J E,Schneider E B,et al.Congestive heart failure and chronic obstructive pulmonary disease predict poor surgical outcomes in older adults undergoing elective diverticulitis surgery[J].Diseases of the Colon&Rectum,2011,54(11):1430-1437
[13]Blonde-Cynober F,Morineau G,Estrugo B,et al.Diagnostic and prognostic value of brain natriuretic peptide(BNP)concentrations in very elderly heart disease patients:Specific geriatric cut-off and impacts of age,gender,renal dysfunction,and nutritional status[J].Archives of gerontology and geriatrics,2011,52(1):106-110
[14]Wannamethee S G,Shaper A G,Whincup P H,et al.Obesity and risk of incident heart failure in older men with and without pre-existing coronary heart disease:does leptin have a role?[J].Journal of the American College of Cardiology,2011,58(18):1870-1877
[15]Joynt K E,Orav E J,Jha A K.The association between hospital volume and processes,outcomes,and costs of care for congestive heart failure[J].Annals of internal medicine,2011,154(2):94-102
[16]Murad K,Kitzman D W.Frailty and multiple comorbidities in the elderly patient with heart failure:implications for management[J].Heart failure reviews,2012,17(4-5):581-588