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目的:总结西宁地区分期复合治疗室间隔缺损和动脉导管未闭合并重肺动脉高压的体会。方法:2008年10月—2011年8月,我科对5例室间隔缺损和动脉导管未闭合并重度肺动脉高压患者进行了一期介入封堵动脉导管未闭,随后择期行室间隔缺损手术治疗的分期复合治疗,术后随访,观察症状,心律变化,封堵伞形态,残余分流,肺动脉压变化,评价治疗效果。结果:5例均成功一期行介入封堵动脉导管未闭。术后造影示PDA均完全封堵,无残余漏,复查超声心动图:PDA分流消失,肺动脉平均压(69±8)mmHg,下降为(54±6)mmHg;二期在体外循环下行室间隔缺损修补手术治疗,肺动脉平均压(54±6)mmHg,下降为(32±8)mmHg,随访中所有患者均未出现右心衰竭和死亡。结论:分期复合治疗室间隔缺损和动脉导管未闭合并重肺动脉高压安全、有效,效果良好,是一种可选择的治疗方法。
OBJECTIVE: To summarize the experience of staging compound therapy for ventricular septal defect and patent ductus arteriosus and pulmonary hypertension in Xining area. Methods: From October 2008 to August 2011, 5 cases of ventricular septal defect and patent ductus arteriosus combined with severe pulmonary hypertension were treated with occlusion of patent ductus arteriosus and followed by elective surgery of ventricular septal defect The patients were followed up and observed the symptoms, changes of heart rhythm, the shape of the occlusion umbrella, the remnant shunts and the changes of pulmonary arterial pressure to evaluate the therapeutic effect. Results: All the 5 cases were successfully involved in the occlusion of patent ductus arteriosus. Postoperative imaging showed PDA were completely blocked, no residual leakage, review echocardiography: PDA shunt disappeared, the average pulmonary pressure (69 ± 8) mmHg, decreased to (54 ± 6) mmHg; second period under cardiopulmonary bypass room interval For defect repair surgery, mean pulmonary artery pressure (54 ± 6) mmHg decreased to (32 ± 8) mmHg, and no right heart failure and death occurred in all patients at follow-up. Conclusion: The staged compound therapy for ventricular septal defect and patent ductus arteriosus and pulmonary hypertension is safe, effective and effective and is an alternative treatment.