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目的 本研究拟探讨小儿复杂先天性心脏病 (先心病 )手术后经左房给儿茶酚胺类药物的可行性。方法 从 19例手术治疗的复杂先心病患儿中 ,随机抽取 6例经左房输注儿茶酚胺 ,其余患儿采取经中心静脉给药。手术前经右颈内静脉安放Swan Ganz导管 ,待术中放入肺动脉。左房给药组患儿 ,穿刺右锁骨下静脉置入 30cm长的 4号深静脉管 ,待手术中经卵圆孔或房间隔缺损放入左房 ,作为手术后经左房给药的通路。两组患儿均在开放循环后 ,分别经左房或中心静脉 ,立即输注多巴胺和多巴酚丁胺 ,剂量为 6～ 10 μg·kg- 1 ·min- 1 ,持续 3d后逐渐减量。分别于停机后即刻及术后 2、4、8、16、2 4、36、48、72h经Swan Ganz导管测量右房压、平均肺动脉压、肺毛嵌顿压 ,用热稀释法测量心输出量 ,然后计算出体循环阻力和肺血管阻力。结果 经左房给药组手术后肺动脉压力及肺血管阻力显著低于经中心静脉给药组 (P <0 0 5 ) ,手术后左房给药组心指数与中心静脉给药组相比无统计学意义 ,两组患儿的其它血液动力学指标无显著差异 (P >0 0 5 )。结论 复杂先心病术后经左房输注正性肌力药物能消除经中心静脉给药引起的肺动脉压力及肺血管阻力升高。
Objective This study was designed to explore the feasibility of pediatric complicated congenital heart disease (CHD) surgery via left atrium for catecholamines. Methods Sixteen children with complex congenital heart disease who were surgically treated were randomly assigned to receive catecholamine infusion via the left atrium and the remaining children received central venous infusion. Swan Ganz catheter was placed in the right internal jugular vein prior to surgery and placed into the pulmonary artery during surgery. Left atrial administration group of children, puncture the right subclavian vein into the 30cm long No. 4 deep vein tube until the surgery by the foramen ovale or atrial septal defect into the left atrium, as the route of postoperative left atrial administration . Both groups of children were open-loop, respectively, through the left atrium or central vein, immediate infusion of dopamine and dobutamine, a dose of 6 ~ 10 μg · kg-1 · min-1, gradually decreased after 3 days . Right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary incarceration pressure were measured immediately after shutdown and at 2,4,8,16,24,36,48,72h after Swan Ganz catheterization respectively. The cardiac output was measured by thermal dilution Volume, and then calculate the systemic resistance and pulmonary vascular resistance. Results The pulmonary artery pressure and pulmonary vascular resistance in the left atria group were significantly lower than those in the central venous group after operation (P <0.05). Compared with the central venous group, Statistically, there was no significant difference in other hemodynamic parameters between the two groups (P> 0.05). Conclusions In patients with complicated congenital heart disease, left atrium infusion of inotropic agents can relieve pulmonary artery pressure and pulmonary vascular resistance caused by central venous administration.