摘要
目的观察和探讨心脏移植患者术前肺动脉压力和肺循环阻力与术后右心功能不全的关系,及降低因术后早期肺动脉高压造成右心功能损害的临床措施。方法 54例接受同种原位心脏移植手术的患者,根据术前肺动脉收缩压(sPAP)≥45mm Hg(1 mm Hg=0.133 kPa)或<45 mm Hg,分为Ⅰ组34例和Ⅱ组20例。统计术前血流动力学指标心排指数(CI)、肺循环阻力(PVR)、中心静脉压(CVP)。Swan-Ganz 导管连续监测术后60 h 内的平均肺动脉压(mPAP)、PVR、CI 等指标的动态变化。床旁超声分别监测和评价术后3、7、14、21天和1个月时的三尖瓣反流程度。术后肺动脉高压及右心功能维护治疗措施包括利尿、NO 吸入、静脉注射前列环素(Ilomedin 20)、血液滤过等。结果本组患者无术后早期死亡(术后30天内)。Ⅰ、Ⅱ组患者术前的 sPAP 分别为(60±12)mm Hg 和(25±9)mm Hg(P<0.01);PVR 分别为(358±150)dyn·s^(-1)·cm^(-5)和(140±68)dyn·s^(-1)·cm^(-5)(P<0.01)。术后早期出现右心功能不全的患者Ⅰ组24/34(70.6%)例,Ⅱ组7/20(35.0%)例,两组比较,差异有统计学意义(P=0.01)。Ⅰ组患者术后早期肺动脉压力和 PVR 仍明显高于Ⅱ组患者,并且在较长的时间后才逐渐下降至正常或仍维持偏高水平。Ⅰ组患者术后早期三尖瓣反流的严重程度高于Ⅱ组患者(P<0.05),但随着术后时间的延长,两组患者三尖瓣反流程度差异无统计学意义。结论心脏移植患者术前肺动脉高压的严重程度是影响术后早期右心功能的关键因素。通过有效的降低和防治术后早期肺动脉高压,降低右心负荷,可以明确降低和缩短因肺动脉高压造成术后早期右心功能损害的严重程度和持续时间,有利于术后早期心功能的恢复并维持良好的远期心功能状态。
Objective To observe the relationship between preoperative pulmonary artery pressure and postoperative right ventricular function in heart transplant patients. Method A total of 54 heart transplant patients were divided to two groups： group Ⅰ （ n = 34 ） ： preoperative pulmonary arterial systolic pressure（sPAP） ≥ 45 mm Hg （ 1 mm Hg = 0. 133 kPa） [ （60 ± 12 ）mm Hg ] ; group Ⅱ （ n = 20 ） ： sPAP 〈45 mm Hg [ （25 ±9） mm Hg]. Cardiac index （CI） , pulmonary circulation resistance （PVR） and CVP were measured preoperatively and up to 60 hours post operation by Swan-Ganz catheter. The extent of tricuspid regurgitation at preoperation and 3, 7, 14, 21, 30 days post operation was evaluated by bedside echocardiography. Postoperative pulmonary hypertension was treated by diuresis, nitrates, llomedin 20 and hemofiltration（CRRT）. Result All patients survived the operation. Preoperative PVR was significantly higher in group I patients than that of group Ⅱ patients [ （358 ± 150） dyn · s^-1 · cm^-5 vs. （ 140±68） dyn · s^-1·cm^-5 , P 〈 0.01 ]. Right heart insufficiency early post operation was more often in group Ⅰ patients than that in group Ⅱ patients （70.6% vs. 35.0%, P〈0.05）. The PVR was higher and tricuspid regurgitation extent severer in group Ⅱ than group Ⅰ early post operation and were similar 30 days post operation. Conclusion Post operative right heart insufficiency was associated to preoperative pulmonary hypertension in heart transplant patients.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第4期337-339,共3页
Chinese Journal of Cardiology
关键词
心脏移植
肺动脉高压
心室功能障碍
右
三尖瓣闭锁不全
Heart transplantation
Pulmonary hypertension
Ventricular dysfunction, fight
Tricuspid valve insufficiency
