可逆性肺动脉高压的治疗在心脏移植围术期的应用

目的：通过早期判断并治疗心脏移植围术期可逆性肺动脉高压,降低移植手术后右心功能衰竭的发生率。方法：20例接受心脏移植手术的病人,术前放置肺动脉导管,测定肺动脉压、肺循环阻力。对肺动脉高压的病人在肺动脉端泵入硝酸甘油、前列腺素E1以确定可逆性。并在术后早期抗排异治疗的基础上应用增强心肌收缩力、降低肺动脉压力、强化氧疗和呼吸管理等综合措施。结果：20例病人中6例出现急性右心功能衰竭,其中4例经治疗后症状改善、出院,2例死亡。结论：术前早期判断并治疗可逆性肺动脉高压,可以有效预防并减少心脏移植术后右心功能衰竭的发生,提高手术成功率。

The Treatment of the Reversibility Pulmonary Artery Hypertension in the Perioperative of Heart transplant

Objective： To estimate and treat the reversibility pulmonary artery hypertension in the perioperative of heart transplant,decrease the incidence rate of right heart failure.Methods： Twenty cases were placed Swan-Ganz catheter before heart transplant opera-tion,measured the pulmonary artery pressure,the pulmonary vascular resistance.If the case with the pulmonary artery hypertension,drop Nitroglycerin or Prostaglandin E1 from the pulmonary artery to determine if pressure was reversible.After the surgery,used comprehen-sive measures of improve myocardial systolic;decrease pulmonary artery pressure;reinforcement the oxygen therapy and the respiratory measurement.Results： Six cases had right heart failure,4 of them improved after treating and discharged from the hospital,2 cases died.Conclusions： To estimate and treat the reversibility pulmonary artery hypertension in early time can prevent and decrease the incidence of the right heart failure effectively,and can also improve the success rate of the operation.