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目的观察前列地尔联合高压氧治疗先天性心脏病伴重度肺动脉高压的临床效果。方法选择2012年1月—2014年6月收治的先天性心脏病伴重度肺动脉高压患儿88例作为研究对象,随机分为对照组和观察组各44例。对照组入院后即给予鼻导管间断吸氧,给予呋塞米5~20 mg/次,3次/d;多巴胺3~5μg/(kg·min);前列地尔2~5 ng/(kg·min);对症治疗心力衰竭(心衰)、肺炎等。观察组在对照组基础上给予高压氧治疗,1次/d。两组均治疗15 d后进行手术。记录两组体外循环时间、主动脉阻闭时间、手术时间、住ICU时间。两组分别于入院、治疗15 d、术后10 d用心导管测定动脉压、体循环压、肺循环阻力、体循环阻力、肺动脉压/主动脉压,采用血气分析仪测定桡动脉血氧饱和度。计量资料组间比较采用t检验,组内比较采用配对t检验,P<0.05为差异有统计学意义。结果治疗15 d时,观察组与对照组动脉压、体循环压、肺循环阻力、体循环阻力、肺动脉压/主动脉压分别为(53.09±10.37)、(80.31±4.08)mm Hg(1 mm Hg=0.133 k Pa)、(925.3±120.3)、(1 431.3±337.7)dyn·s/cm5、(0.68±0.17)、(57.03±8.93)、(77.46±5.52)mm Hg、(944.28±228.9)、(1 350.6±270.4)dyn·s/cm5、(0.70±0.25),均较入院时的(63.54±7.09)、(82.50±4.06)mm Hg、(1 053.1±166.3)、(1 493.4±300.7)dyn·s/cm5、(0.76±0.19)、(60.97±5.90)、(80.73±4.01)mm Hg、(1 046.6±203.1)、(1 479.6±304.6)dyn·s/cm5、(0.73±0.21)降低,观察组血氧饱和度为(0.96±0.03),较入院时的(0.90±0.01)升高,差异均有统计学意义(均P<0.05)。术后10 d,观察组与对照组动脉压、肺循环阻力、肺动脉压/主动脉压分别为(48.75±8.32)mm Hg、(735.6±104.8)dyn·s/cm5、(0.64±0.20)、(51.95±6.68)mm Hg、(770.5±148.8)dyn·s/cm5、(0.64±0.20),均较入院时降低,观察组血氧饱和度为(0.97±0.02),较入院时升高,差异均有统计学意义(均P<0.05)。治疗15 d时,观察组动脉压、肺循环阻力均低于对照组,血氧饱和度高于对照组,差异均有统计学意义(均P<0.05)。结论前列地尔联合高压氧治疗先天性心脏病伴重度肺动脉高压可显著降低肺动脉压力,优于单独药物治疗。
Objective To observe the clinical effect of alprostadil combined with hyperbaric oxygen on congenital heart disease with severe pulmonary hypertension. Methods From January 2012 to June 2014, 88 children with congenital heart disease complicated with severe pulmonary hypertension were enrolled in this study. They were randomly divided into control group and observation group, 44 cases each. The control group was given nasal catheter intermittent oxygen after admission, giving furosemide 5 ~ 20 mg / time, 3 times / d; dopamine 3 ~ 5μg / (kg · min); alprostadil 2 ~ 5 ng / (kg · min); symptomatic treatment of heart failure (heart failure), pneumonia and so on. The observation group was given hyperbaric oxygen on the basis of the control group, once a day. Both groups were treated 15 days after surgery. Record two sets of cardiopulmonary bypass time, aortic occlusion time, operation time, live ICU time. The arterial pressure, systemic pressure, resistance to pulmonary circulation, systemic resistance, pulmonary arterial pressure / aortic pressure were measured by cardiac catheter after 15 days of admission, 15 days of treatment and 10 days after operation respectively. The radial arterial oxygen saturation was measured by blood gas analyzer. Measurement data were compared between groups using t test, the group was compared using paired t test, P <0.05 for the difference was statistically significant. Results The arterial pressure, systemic pressure, pulmonary resistance, systemic resistance and pulmonary arterial pressure / aortic pressure in the observation group and the control group were (53.09 ± 10.37), (80.31 ± 4.08) mm Hg (1 mm Hg = 0.133 kPa, (925.3 ± 120.3), (431.3 ± 337.7) dyn · s / cm5, (0.68 ± 0.17), (57.03 ± 8.93), (77.46 ± 5.52) mm Hg, (944.28 ± 228.9) (63.54 ± 7.09), (82.50 ± 4.06) mm Hg, (1 053.1 ± 166.3), (1 493.4 ± 300.7) dyn · s / cm5, (0.76 ± 0.19), (60.97 ± 5.90), (80.73 ± 4.01) mm Hg, (10416.6 ± 203.1), (1479.6 ± 304.6) dyn · s / cm5, (0.73 ± 0.21) Oxygen saturation in observation group was (0.96 ± 0.03), which was significantly higher than that in admission group (0.90 ± 0.01) (all P <0.05). The arterial pressure, pulmonary resistance and pulmonary arterial pressure / aortic pressure in the observation group and the control group were (48.75 ± 8.32) mm Hg, (735.6 ± 104.8) dyn · s / cm5, (0.64 ± 0.20) 51.95 ± 6.68) mmHg, (770.5 ± 148.8) dyn · s / cm5 and (0.64 ± 0.20), respectively, which were lower than those at admission. The oxygen saturation in observation group was (0.97 ± 0.02) All were statistically significant (P <0.05). At 15 days after treatment, the arterial pressure and pulmonary resistance in the observation group were lower than those in the control group, and the oxygen saturation was higher than that in the control group (all P <0.05). Conclusion Alprostadil combined with hyperbaric oxygen treatment of congenital heart disease with severe pulmonary hypertension can significantly reduce pulmonary artery pressure, better than single drug treatment.