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目的:观察术前前列地尔联合高压氧(hyperbaricoxygen,HBO)治疗对先天性心脏病伴发重度肺动脉高压患者的临床疗效。方法:按随机数字表法将49例室间隔缺损伴发重度肺动脉高压的患者分为对照组(n=25,常规治疗)和观察组(n=24,常规治疗+HBO辅助治疗),常规治疗以多巴胺[3-5μg/(kg·min)]、呋塞米片(5-20 mg/次,3/日)、前列地尔[2~5 ng/(kg·min)]等药物治疗以及常压间断吸氧(每次0.5 h,3次/日)治疗为主。比较2组患者入院时(T1)、术前治疗15 d后(T2)和术后治疗10 d后(T3)三个时间点体肺血流动力学变化。结果:对照组及观察组患者的平均肺动脉压(m PAP)、肺循环阻力(PVR)和肺动脉压/主动脉压比值(Pp/Ps)经术前综合治疗15 d后分别下降为(57.08±9.44)/(53.16±11.61)mm Hg、(943.81±245.86)/(927.21±119.27)dyns/cm5和(0.70±0.17)/(0.68±0.13),经术后治疗10 d后进一步下降;两组动脉血氧饱和度(Sa O2)术前治疗15 d及术后治疗10 d后均较入院时高升,而平均体循环压(m SAP)和体循环阻力(SVR)经术前治疗15d后(T2)略有下降(P<0.05),但在术后10 d(T3)恢复至入院时水平(T1)。与对照组相比,观察组m PAP和PVR值经术前治疗15 d后(T2)下降更显著,Sa O2上升也更为明显(P<0.05)。结论:对于先天性心脏病伴发重度肺动脉高压的患者,术前给予前列地尔药物降压的同时辅以HBO治疗可有效降低肺动脉压,提高血氧饱和度,可为手术的实施和减少术后并发症提供有利条件。
Objective: To observe the clinical effect of preoperative alprostadil combined with hyperbaric oxygen (HBO) on congenital heart disease patients with severe pulmonary hypertension. Methods: A total of 49 patients with ventricular septal defect complicated with severe pulmonary hypertension were randomly divided into control group (n = 25, conventional treatment) and observation group (n = 24, conventional therapy plus HBO adjuvant therapy) Treatment with dopamine [3-5 μg / (kg · min)], furosemide tablets (5-20 mg / time, 3 / day) and alprostadil [2-5 ng / (kg · min) Atmospheric pressure intermittent oxygen (0.5 h each time, 3 times / day) treatment-based. The pulmonary hemodynamic changes were compared between the two groups at admission (T1), 15 days after preoperative treatment (T2) and 10 days after postoperative treatment (T3). Results: The average pulmonary arterial pressure (m PAP), pulmonary vascular resistance (PVR) and pulmonary artery pressure / aortic pressure ratio (Pp / Ps) in control group and observation group decreased to 57.08 ± 9.44 ) / (53.16 ± 11.61) mmHg, (943.81 ± 245.86) / (927.21 ± 119.27) dyns / cm5 and (0.70 ± 0.17) / (0.68 ± 0.13), respectively. Blood oxygen saturation (Sa O2) increased 15 days before surgery and 10 days postoperatively compared with that at admission, while mean arterial pressure (m SAP) and systemic resistance (SVR) after pretreatment for 15 days (T2) (P <0.05), but recovered to the level of admission (T1) after 10 days (T3). Compared with the control group, m PAP and PVR in the observation group decreased more significantly (P <0.05) after 15 days of preoperative treatment (P <0.05). Conclusion: For patients with congenital heart disease complicated with severe pulmonary hypertension, preoperative alprostadil antihypertensive drugs supplemented with HBO can effectively reduce pulmonary arterial pressure and improve oxygen saturation, which can be used for surgery and reduce the operation Post complications provide favorable conditions.