牛心包补片修补心脏缺损并雾化吸入伊洛前列环素降低肺动脉高压韩宏光，韩劲松，王辉山，方敏华，李波，李晓密，徐莉莹，孟庆涛解放军沈阳军区总医院心血管外科，辽宁省沈阳市110016BovinepericardiumpatchrepairsheartdefectsandaerosolizediloprostreducespulmonaryhypertensionHanHong-guang,Han激n-song,WangHui-shan,FangMin-hua,LiBo,LiXiao-mi,XuLi-ying,MengQing-taoDepartmentofCardiovascularSurgery,GeneralHospitalofShenyangMilitaryAreaCommandofPLA,Shenyang110016,LiaoningProvince,China摘要背景：对于先天性心脏病合并肺动脉高压的治疗，传统降低肺动脉高压的药物效果确实，但存在不易监测、停药后反跳等现象；传统的心脏涤纶补片较易引起吻合口变形、血栓、栓塞、溶血和感染等并发症。目的：观察应用戊二醛处理牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压的效果。方法：选择90例先天性心脏病合并肺动脉高压患者，术中采用戊二醛处理的牛心包补片修补心脏间隔缺损，术后雾化吸入伊洛前列环素30ng/(min•kg)，日间12h按1次/4h给药，夜间12h按1次/6h给药，连续给药2d。记录每次吸入药物前、吸入后即刻、吸入30min后平均动脉压、平均肺动脉压、体循环阻力指数与肺循环阻力指数，于随访期观察有无心包材料相关并发症和心功能情况。结果与结论：90例患者复查超声心动图见活瓣均已关闭，无分流，心脏间隔缺损无回声中断，心脏收缩功能正常，未发现与牛心包补片相关的不良反应。所有患者不同时间点平均动脉压、体循环阻力指数比较差异无显著性意义。患者吸入药物后即刻平均肺动脉压、肺循环阻力指数明显低于吸入药物前(P<0.01)，吸入30min后平均肺动脉压、肺循环阻力指数亦明显低于吸入药物前(P<0.05)。表明应用戊二醛处理的牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压安全、有效。中国组织工程研究杂志出版内容重点：生物材料；骨生物材料;口腔生物材料;纳米材料;缓释材料;材料相容性；组织工程全文链接：关键词：生物材料；材料相容性；牛心包补片；心脏间隔缺损；修复；肺动脉高压；先天性心脏病；伊洛前列环素；Abstract：BACKGROUND:Thetreatmentofpulmonaryhypertensionsecondarytocongenitalheartdiseasehasbeenahottopicintheclinicalresearchoncardiacsurgery.Althoughtraditionaldrugsforreducingpulmonaryhypertensionhaveexcellenteffects,therearesomedefaults,suchasdifficultmonitoringandreboundingphenomenonafterdrugwithdrawal.Thetraditionalheartdacrongraftispronetocausecomplications,suchasdeformation,thrombosis,embolism,hemolysisandinfection.OBJECTIVE:Toinvestigatetheeffectofglutaraldehyde-fixedbovinepericardiumpatchandaerosolizediloprostinpatientswithpulmonaryhypertensionsecondarytocongenitalheartdisease.METHODS:Ninetypatientswithpulmonaryhypertensionduetocongenitalheartdiseaseunderwentasurgery.Glutaraldehyde-treatedbovinepericardiumpatchwereusedtorepaircardiacseptaldefect,andthenaerosolizediloprostwasappliedafteroperation,administeredfor3daysaccordingto30ng/min/kg,every4hoursinthefirst12hoursofaday,andevery6hoursintheresting12hours.Meanarterialpressure,meanpulmonaryarterialpressure,systemicvascularresistanceindex,pulmonaryvascularresistanceindexwererecordedbeforeinhalation,immediatelyafterinhalation,and30minutesafterinhalation.Thepericardium-associatedcomplications,andcardiacfunctionwerealsoobservedatfollow-ups.RESULTSANDCONCLUSION:Theinvolved90casesweredetectedbyechocardiography.Theresultsshowedthat,alltheflapswereclosed,therewasnoshuntingorechodiscontinuationofatrialseptum.Theheartcontractionfunctionwasnormal.Nopericardium-associatedcomplicationswerefound.Therewasnosignificantdifferenceinthemeanarterialpressureandsystemicvascularresistanceindexinallpatientsatdifferenttimepoints....
