米力农对先天性心脏病肺动脉高压患者术前血液动力学的效应-心胸外科专业毕业论文.docxVIP

山西医科大学 山西医科大学 硕士学位论文 米力农对先天性心脏病肺动脉高压患者 术前血液动力学的效应 研究生王晋旺 导师李家成教授 郭光伟副教授 摘 要 【目的】：观察静脉注射米力农对先天性心脏病合并肺动 脉高压患者术前血液动力学的影响，探讨其临床实用价值。 【方法】：25例先天性心脏病合并肺动脉高压患者被分为 两组。A组：14例，中度肺动脉高压组；B组：11例，重度 肺动脉高压组。应用彩色多普勒超声心动图检测静脉注射米力 农后两组肺动脉收缩压(PASP)的变化，以及用药后2分钟、 5分钟、30分钟时的下降程度，比较两组患者术后低心排出量 综合征，心律失常、死亡例数。 【结果】：静脉注射米力农后，两组患者的肺动脉收缩压 一1一 山西医科大学 山西医科大学 硕士学位论文 均明显下降(P0．01)，以用药后5分钟时最显著(P0．01)； 体循环血压变化不明显(P0．05)。A组肺动脉收缩压下降明 显，与B组比较有差异。PASP较用药前下降15mmHg以上者， 术后心功能恢复快；下降在10．15mmHg之间者，术后出现不 同程度的并发症；下降在10mmHg以下者，死亡率较高。 【结论】：米力农选择性地作用肺血管，降低肺动脉压力， 可用于先天性心脏病肺动脉高压患者术前肺血管病变的评估。 【关键词】：先天性心脏病 肺动脉高压 血液动力学 米力农 生望垦翌垄鲎 生望垦翌垄鲎 塑主兰堡笙墨。 Hcmodynamic Effect of Infusion Milrinone in Patients of Congenital Heart Disease Associated With Pulmonary Hypertension Before Operation Abstract Objectve：The purpose of this study was to examine the hemodynamic effects of a venous infusion of milrinone in patients of congenital heart disease(CHDl with pulmonary hypertension(PH) Methods：Twenty—five patients with CHD associated with PH were divided into two groups，group A(n=14)：the middle PH．group B(n=l 11：the severe PH．Pulmonary artery systolic pressure(PASP)of two groups was detected by c Color·Doppler echocardiography(CDFI)after intravenous injecting milrinone，and then observed PASP change at time of two minutes、five minutes、ten minutes．Low cardiac output syndrome(LCOS)、arrhythmic and mortality —-3一 山西医科大学 山西医科大学 硕士学位论文 after operation were compared between two groups Results：PASP descended obviously in two groups(PO．01)，and PASP descensus was the most significant at five minutes after intravenous injecting milrinone rP0．01)；it wasn’t obvious about the systemic blood pressure(PO．05)．PASP descensus was obvious in group A．If patients’PASP descendens degree was larger than 1 5mmHg，then operation was safety；if patients’PASP descendens degree was from 1 0 to 1 5mmHg．then patients symptom appear different degree after operation：if patients’PASP descendens degree was lower than 10mmHg．then mortality was very high Conclusion：Milrin