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目的:探讨婴幼儿先天性心脏病合并重度肺动脉高压手术的围术期管理经验。方法:138例3岁以下婴幼儿先天性心脏病合并重度肺动脉高压患儿,术前静注前列腺素E1降低肺动脉压力;术中注意保护肺脏和心肌,维持血流动力学稳定,体外循环后采用改良超滤法;术后予血管活性药物,前列腺素E1、氧化亚氮吸入。结果:患儿术前肺动脉压(68.33±17.13)mmHg(1 mmHg=0.133 kPa),术后1天肺动脉压(38.15±19.37)mmHg,术后较术前有明显下降(P<0.05)。全组死亡9例,129例患儿痊愈出院。结论:合理的围术期管理可以协助先天性心脏病合并中重度肺动脉高压患儿平稳度过围手术期。
Objective: To explore the perioperative management experience of infantile congenital heart disease complicated with severe pulmonary hypertension. Methods: 138 infants under 3 years old with congenital heart disease complicated with severe pulmonary hypertension, preoperative intravenous prostaglandin E1 reduce pulmonary artery pressure; intraoperative attention to protect the lungs and myocardium to maintain hemodynamic stability after cardiopulmonary bypass Modified ultrafiltration; Postoperative vasoactive drugs, prostaglandin E1, nitrous oxide inhalation. Results: Preoperative pulmonary arterial pressure (68.33 ± 17.13) mmHg (1 mmHg = 0.133 kPa) and pulmonary arterial pressure at 1 day after operation (38.15 ± 19.37) mmHg were significantly lower than those before operation (P <0.05). The whole group died of 9 cases, 129 patients were discharged. Conclusion: Reasonable perioperative management can help patients with congenital heart disease complicated by moderate and severe pulmonary hypertension during perioperative period.