摘要
目的探讨靶向药物联合介入治疗先天性心脏病合并重度肺动脉高压患者的安全性及疗效,寻求合理的治疗方案。方法回顾分析采用靶向药物联合介入封堵治疗的23例先天性心脏病合并重度肺动脉高压患者临床资料并随访观察。结果 23例中PDA 19例,ASD 1例,PDA并ASD 2例,PDA并VSD 1例。封堵成功14例,其中即刻封堵11例,延期封堵3例。封堵后与封堵前比较患者股动脉血氧饱和度由(90.4±2.7)%升至(93.1±2.2)%(P<0.01),肺动脉收缩压由(104.8±16.5)mm Hg降至(82.3±33.9)mm Hg(P<0.01),主动脉压由(137.1±14.7)mm Hg升高至(140.5±18.1)mm Hg(P>0.05)。封堵失败9例,其中右心导管检查后股动脉氧饱和度<90%且PVR>15 wood者6例,试封堵后肺动脉收缩压无明显下降甚至升高者3例。平均随访(38.3±20.9)个月,无死亡病例。14例中13例封堵术后肺动脉收缩压持续下降至正常水平,其中1例肺动脉收缩压逐渐上升至90 mm Hg,6 min步行试验距离由术前(343±102)m增加至(505±87)m(P<0.05)。9例未封堵患者肺动脉收缩压由(114.2±36.6)mm Hg降至(108.3±32.7)mm Hg(P>0.05),6 min步行试验距离由术前(316±103)m增加至(386±95)m(P<0.05)。结论靶向药物联合介入治疗先天性心脏病合并重度肺动脉高压是安全的,效果较好。封堵前的综合评估及围手术期规范治疗是患者获益的最大保证。
Objective To study the safety and efficacy of targeted drugs and interventional treatment of congenital heart disease and severe pulmonary hypertension .Methods The clinical data and experience in 23 patients with congenital heart disease and severe pulmonary hypertension ( PAH-CHD ) were reviewed from March 2008 to June 2012 .Results In all 23 patients ,19 cases were PDA ,1 case was ASD ,2 cases were PDA and ASD , 1 case was PDA and the VSD .14 cases were successfully occluded ,and 9 inoperable patients .Compared with the level before operation , femoral arterial oxygen saturation was higher ( P<0.01 ) , and pulmonary artery systolic pressure was lower(P<0.01),the aortic pressure was higher(P>0.05).No deaths after average(38.3 ±20.9) months follow-up.13 patients in 14 operable cases were found to have no postoperative PAH ,and 6 minutes walk test distance was higher ( P<0.05 ) .In 9 inoperable patients ,the pulmonary artery systolic pressure was lower ( P>0.05 ) , 6 minutes walk test distance was higher ( P <0.05 ) .Conclusion Targeting therapy and interventional treatment for congenital heart disease with severe pulmonary hypertension are safe and effective .
出处
《心血管外科杂志（电子版）》
2014年第1期19-22,共4页
Journal of Cardiovascular Surgery(Electronic Edition)
关键词
心脏缺损
先天性
高血压
肺性
放射学
介入性
靶向药物
Heart defects,congenital
Hypertension,pulmonary
Radiology,interventional
Targeted therapy
