成年人房间隔缺损封堵后肺动脉压变化研究.docVIP

成年人房间隔缺损封堵后肺动脉压变化研究 　　[摘要]目的 分析成年人房间隔缺损封堵后肺动脉压变化情况。方法 选择2013年4月～2014年4月在我院接受治疗的房间隔缺损患者25例，均在胸超声心动图监测下使用封堵器对房间隔缺损进行封堵，分析封堵前后肺动脉压变化、动脉血气分析以及气道压波动。结果 25例房间隔缺损患者封堵后的心导管肺动脉收缩压及舒张压分别为（35.66±10.53）、（22.85±5.42）mmHg，明显低于封堵前的（46.90±8.49）、（29.93±5.36）mmHg（P0.01）；患者术后左室每搏量、左室射血分数（术后2 d除外）明显高于术前，术后右房内径以及主肺动脉压均低于术前，术后（术后2 d除外），左室偏心指数、左室L/D显著小于术前（P0.05）。随访12个月，心室重构持续性逆转，术前及术后12个月心脏血流动力学数据差异有统计学意义（P0.05）。结论 成年人房间隔缺损在经胸心动图监测开展房间隔缺损封堵术后，可有效缓解右心负荷，缩小左室偏心指数，改善血流动力学指标，同时还可逆转心脏重构进程，术后3个月，多数患者心功能恢复至正常水平。 　　[关键词]成年患者；房间隔缺损；封堵器；肺动脉压；心功能 　　[中?D分类号] R541.1 [文献标识码] A [文章编号] 1674-4721（2017）10（a）-0036-03 　　[Abstract]Objective To analyze the change of pulmonary arterial pressure in adult patients after occlusion of atrial septal defect （ASD）.Methods 25 patients with ASD treated in our hospital from April 2013 to April 2014 were selected，and they were given occlusion of ASD by using occluder under the monitoring of Trans-Thoracic Echocardiography （TTE）.The pre- and post-occlusional change of pulmonary artery pressure， arterial blood gas and airway pressure fluctuation were analyzed.Results The post-occlusional pulmonary artery systolic pressure （PASP） and pulmonary artery diastolic pressure （PADP） of 25 ASD patients was （35.66±10.53） mmHg and （22.85±5.42） mmHg respectively，and it was lower than that of pre-occlusion [（46.90±8.49） mmHg and （29.93±5.36） mmHg] respectively （P0.01）.Postoperative left ventricular stroke volume，left ventricular ejection fraction （except after 2 days operation） was significantly higher than the preoperative，and the right atrium diameter and the main pulmonary arterial pressure were lower than those before operation，after operation （except after 2 days operation），left ventricular eccentricity index and left ventricular L/D were significantly smaller than those before operation （P0.05）.After 12 months of follow-up，the ventricular remodeling was continuously reversed.There were significant differences in the hemodynamic data between before operation and after 12 month