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目的:研究先天性心脏病(CHD)并发重度肺动脉高压(PAH)介入封堵联合盐酸伐地那非综合治疗的应用。方法:术前、后常规给予29例患者口服盐酸伐地那非治疗,对有介入封堵适应证的患者置入封堵器进行试验性封堵测压,若肺动脉压降低幅度为原来压力的20%或下降30mmHg(1mmHg=0.133kPa)以上后进行永久封堵,术后继续采用超声多普勒心动图随访患者肺动脉收缩压(SPAP)、肺循环、体循环收缩压比值(Pp/Ps)、右室大小(RV)、左室射血分数(LVEF)12个月。结果:本组29例患者经术前、后常规予盐酸伐地那非治疗后,27例行介入试验性封堵测压,随后有25例肺动脉压降低幅度为原来压力的20%或下降30mmHg以上。对这25例患者进行永久封堵,且5例使用带孔封堵器,随访12个月,除1例死亡外,其余心功能恢复Ⅰ级以上、动脉血氧饱和度(SaO2)均恢复在0.95以上、SPAP、Pp/Ps、LVEF、RV均有显著改善(均P<0.05)。4例无法封堵的患者除1例转心外科手术后死亡外,其余心功能由Ⅳ级恢复到Ⅲ级、SaO2在0.90以上、动脉血氧分压>60mmHg。结论:介入试验性封堵联合盐酸伐地那非综合治疗微创、简便、安全、可靠,给CHD并发重度PAH的患者带来根治的希望。
Objective: To study the application of combined therapy of congenital heart disease (CHD) with severe pulmonary hypertension (PAH) in the treatment of vardenafil combined with blocking therapy. Methods: Before and after routine administration of 29 cases of vardenafil hydrochloride hydrochloride treatment, indications of interventional occlusion indications of patients with occlusion device for the test closure of the manometry, if the pulmonary artery pressure decreased by the original pressure 20%, or 30mmHg (1mmHg = 0.133kPa) respectively, and the pulmonary artery systolic pressure (SPAP), pulmonary circulation, systemic systolic pressure ratio (Pp / Ps) Room size (RV), left ventricular ejection fraction (LVEF) for 12 months. Results: Twenty-nine patients were treated with varicose verapamil routinely before and after the routine treatment, and then were included in the study. Twenty-seven patients underwent experimental blockade manometry, followed by 25% reduction in pulmonary arterial pressure by 20% or 30 mmHg the above. The 25 patients were permanently occluded, and 5 patients with perforated occluders were followed up for 12 months. Except for 1 case, all other cardiac functions recovered more than grade Ⅰ, and arterial oxygen saturation (SaO2) recovered Above 0.95, SPAP, Pp / Ps, LVEF and RV were significantly improved (all P <0.05). In 4 patients who could not be blocked except for one patient who died of cardiac surgery, the rest of the cardiac function recovered from grade Ⅳ to grade Ⅲ, SaO2 was above 0.90 and arterial oxygen pressure was above 60 mmHg. CONCLUSION: The minimally invasive, simple, safe and reliable interventional trial combined with vardenafil hydrochloride combined with minimally invasive treatment brings radical hope to patients with CHD complicated with severe PAH.