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| 成人先天性心脏病合并重度肺动脉高压的心内直视手术治疗经验探讨 |
| Open heart surgery under cardiopulmonary bypass for adult patients with congenital heart disease complicated with severe pulmonary hypertension |
| 投稿时间：2022-04-14 |
| DOI：10.3969/j.issn.1000-0399.2022.09.004 |
| 中文关键词: 成人,先天性心脏病 肺动脉高血压 心内直视手术 体外循环 |
| 英文关键词: Adult,congenitalheart disease Pulmonary hypertension Intracardiac surgery Cardiopulmonary bypass |
| 基金项目:安徽高校省级自然科学研究项目(项目编号:KJ2018A0180) |
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| 中文摘要: |
| 目的 总结成人先天性心脏病合并重度肺动脉高压患者在体外循环下心内直视手术的处理经验,探讨此类患者手术指征、手术时机,以提高手术效果。方法 回顾性分析2016年1月至2021年12月在安徽医科大学第一附属医院心脏大血管外科行体外循环下心内直视手术治疗的62例18岁及以上先天性心脏病合并重度肺动脉高压患者相关资料,归纳患者术前、术后及随访(通过门诊及电话随访2～40月)时的肺动脉压力、心脏大小、心功能等指标,统计患者死亡和严重并发症情况,同时按照手术入路不同分组(微创手术组、常规手术组),比较两种手术治疗效果的差异。结果 患者术前、术后及随访时的肺动脉压力、左房大小、左室舒张末期直径与射血分数比较,差异均无统计学意义(P＞0.05)。62例患者术后早期死亡4例,死亡率6.5%;肺部感染22例(35.5%),低心排综合征4例(6.5%),低氧血症4例(6.5%),肺动脉高压危象1例(1.6%)。随访期间,失访7例,无随访死亡病例,患者肺动脉压力控制满意,心功能均为Ⅱ级及以上,手术效果良好。微创手术与常规手术治疗效果比较,差异均无统计学意义(P>0.05)。结论 成人先天性心脏病合并重度肺动脉高压患者的心内直视手术治疗的效果满意,微创手术与常规手术治疗效果一致。 |
| 英文摘要: |
| Objective To summarize the experience of perioperative management of open heart surgery under cardiopulmonary bypass for adult patients with congenital heart disease complicated with severe pulmonary hypertension, and to explore the surgical indications, timing and methods of surgery for such patients in order to improve the surgical effect. Methods The clinical data of 62 cases of congenital heart disease patients over 18 years old with severe pulmonary hypertension who received open heart surgery under cardiopulmonary bypass in the Department of Cardiovascular surgery, the First Affiliated Hospital of Anhui Medical University, from January 2016 to December 2021 were retrospectively analyzed, including summarizing preoperative, postoperative and follow-up (through outpatient and telephone follow-up of 2~40 months) of pulmonary artery pressure and cardiac size and cardiac function indexes.The cases of death and serious complications were summarized, and the causes were analyzed; at the same time, according to different surgical approaches, they were divided into different groups (minimally invasive surgery and conventional surgery), and the therapeutic effects were compared.Results There was no significant difference in PAP, LA, LVD and EF before operation, after operation and during follow-up (P>0.05).Four deaths occurred early after surgery, with a mortality of 6.5%, 22 postoperative pulmonary infections(35.5%), 4 hypocardiac syndrome(6.5%), 4 hypoxemia(6.5%) and 1 pulmonary hypertension crisis(1.6%).During the follow-up,seven cases were missed, with no follow-up deaths. The pulmonary hypertension was controlled satisfactorily, the cardiac function was gradeⅡor above, and the surgical effect was good.There was no significant difference between minimally invasive surgery and conventional surgery (P>0.05).Conclusions The effect of open-heart surgery in patients of adult congenital heart disease with severe pulmonary hypertension is satisfactory,and the results of minimally invasive surgery are consistent with those of conventional surgery. |
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