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目的:探究房水平单向活瓣式补片对老年先天性心脏病伴重度肺动脉高压患者的作用疗效。方法:选取我院心血管科收治的先天性心脏病伴重度肺动脉高压患者80例,随机分为对照组和实验组。对照组40例,予以常规基础药物治疗(波生坦);实验组,在基础药物治疗两个疗程后,采用房水平单向活瓣式补片进行手术治疗。比较两组患者治疗前后的肺动脉压(PAP)、体动脉压(SAP)、肺动脉压/体动脉压(PAP/SAP)、动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)及吸氧浓度、右室收缩末期内径变化情况。结果:治疗后,与对照组比较,实验组肺动脉压下降幅度较大(P<0.05);与治疗前比较,实验组肺动脉压与体动脉压的比值显著下降,且优于对照组(P<0.05);治疗后,实验组动脉血氧分压、二氧化碳分压以及吸氧浓度显著优于对照组(P<0.05);治疗后,实验组患者右室收缩末期内径显著小于对照组(P<0.05);随访结果:实验组死亡1例、术后活瓣坏死2例、其余37例病情均转好且无复发情况;对照组死亡4例、出现各项并发症16例、剩余20例病情转好。结论:房水平单向活瓣式补片法可有效改善患者的肺动脉压、体动脉压、动脉血氧分压、二氧化碳分压及吸氧浓度、右室收缩末期内径及6 min步行距离,对老年先天性心脏病伴重度肺动脉高压患者疗效显著。
Objective: To investigate the effects of horizontal unilateral valved patch on senile congenital heart disease with severe pulmonary hypertension. Methods: 80 cases of congenital heart disease with severe pulmonary hypertension admitted to our hospital were randomly divided into control group and experimental group. Control group, 40 cases, to be treated with conventional basic drugs (bosentan); experimental group, two courses of treatment in the basic drugs, the use of atrial horizontal one-way valve flap for surgical treatment. The changes of pulmonary arterial pressure (PAP), arterial pressure (SAP), pulmonary arterial pressure / arterial pressure (PAP / SAP), Pa O2 and Pa CO2 before and after treatment were compared between the two groups Oxygen concentration, end-systolic diameter changes. Results: Compared with the control group, the decrease of pulmonary arterial pressure in the experimental group was significant (P <0.05) after treatment. The ratio of pulmonary arterial pressure to body arterial pressure in the experimental group was significantly lower than that in the control group (P < 0.05). After treatment, arterial partial pressure of oxygen, partial pressure of carbon dioxide and oxygen concentration in experimental group were significantly better than those in control group (P <0.05). After treatment, the diameter of right ventricular end-stage in experimental group was significantly smaller than that of control group (P < 0.05). The follow-up results: In the experimental group, 1 patient died, 2 patients had post-operative valve necrosis, and the rest 37 patients recovered without any recurrence. In the control group, 4 patients died, 16 patients had complications and the remaining 20 patients improving. CONCLUSION: The one-way horizontal valvular patch method can effectively improve pulmonary arterial pressure, arterial pressure, arterial partial pressure of oxygen, partial pressure of carbon dioxide and oxygen concentration, end-systolic diameter of right ventricle and walking distance of 6 min. Elderly congenital heart disease with severe pulmonary hypertension patients with significant effect.