發(fā)布時(shí)間：2018-03-19 18:27

  本文選題：先天性心臟病　切入點(diǎn)：肺動(dòng)脈高壓　出處：《吉林大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的：肺動(dòng)脈高壓是一種嚴(yán)重危害人類生命健康的疾病，據(jù)保守估計(jì)，目前全國(guó)大概有1300萬(wàn)名肺動(dòng)脈高壓患者。肺動(dòng)脈高壓分為原發(fā)性和繼發(fā)性兩種，先天性心臟病是引起繼發(fā)性肺動(dòng)脈高壓的常見(jiàn)原因。而經(jīng)導(dǎo)管封堵是治療先天性心臟病積極有效途徑，減緩或改善高肺血流所致肺血管結(jié)構(gòu)重建和肺動(dòng)脈高壓的形成，對(duì)于先天性心臟病患者手術(shù)的成功及其預(yù)后的改善甚為重要。血漿腦鈉素（BNP）與心力衰竭、急性冠脈綜合癥、原發(fā)性高血壓等疾病有密切關(guān)系，BNP的釋放與壓力呈相關(guān)性，且與肺動(dòng)脈高壓程度相關(guān),可作為特發(fā)性肺動(dòng)脈高壓預(yù)測(cè)預(yù)后的獨(dú)立因子。本文旨在討論先天性心臟病合并肺動(dòng)脈高壓經(jīng)藥物治療與經(jīng)導(dǎo)管行封堵術(shù)后血漿BNP濃度變化及對(duì)預(yù)后的影響。 方法：本研究收集2010年2月-2012年2月我院心內(nèi)科先天性心臟病患者為研究對(duì)象,以多普勒超聲檢查提示肺動(dòng)脈收縮壓≥40mmHg為肺動(dòng)脈高壓初步診斷標(biāo)準(zhǔn)，排除合并其他器質(zhì)性心臟病、高血壓病、先天性復(fù)合畸形、腎功能異常、心功能不全患者，共有20例患者納入研究，其中男性8例，女性12例，房間隔缺損（ASD）10例,室間隔缺損（VSD）4例，動(dòng)脈導(dǎo)管未閉（PDA）6例。9名先天性心臟�。–HD）患者按先心病介入治療常規(guī)操作成功實(shí)行封堵術(shù)，術(shù)中測(cè)量肺動(dòng)脈壓力，分別于術(shù)前、術(shù)后第二天，術(shù)后一個(gè)月抽取靜脈血5ml，采用酶聯(lián)免疫法測(cè)定血漿BNP水平，同時(shí)比較10例先天性心臟病伴肺動(dòng)脈高壓患者經(jīng)藥物治療前及一個(gè)月后血漿BNP水平變化。并于介入治療術(shù)前及術(shù)后一周內(nèi)行二維超聲心動(dòng)圖檢查，觀察各房室大小、左室后壁（LVPW）、左室短軸縮短率（LVFS）、動(dòng)脈血氧飽和度（SO2）、6min步行距離試驗(yàn)（6MWT）及肺動(dòng)脈壓力（PAP）的變化。 結(jié)果：9例先天性心臟病伴肺動(dòng)脈高壓患者成功接受介入治療，手術(shù)順利，無(wú)并發(fā)癥，封堵術(shù)后即刻經(jīng)導(dǎo)管測(cè)定肺動(dòng)脈壓力下降。介入治療1個(gè)月后LWPW、LVFS有所下降，，但無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后24小時(shí)測(cè)定血漿BNP水平下降，部分室間隔缺損患者BNP水平較術(shù)前上升,術(shù)后一個(gè)月測(cè)定血漿BNP水平明顯下降并有統(tǒng)計(jì)學(xué)意義。藥療患者明顯。 結(jié)論： 1.先天性心臟病伴肺動(dòng)脈壓高壓患者血漿BNP水平均有不同程度增高。 2.經(jīng)導(dǎo)管介入封堵術(shù)后一個(gè)月血漿BNP水平較術(shù)前明顯降低并有統(tǒng)計(jì)學(xué)意義。經(jīng)導(dǎo)管封堵術(shù)治療先天性心臟病伴肺動(dòng)脈高壓患者血漿BNP下降水平較經(jīng)傳統(tǒng)藥物治療下降幅度明顯，并有統(tǒng)計(jì)學(xué)意義。 3.部分室間隔缺損伴肺動(dòng)脈高壓患者介入治療后24小時(shí)內(nèi)并未出現(xiàn)預(yù)想中肺動(dòng)脈壓力下降至血BNP濃度降低，反而輕度升高，考慮可能原因?yàn)槭中g(shù)過(guò)程中反復(fù)機(jī)械刺激心臟或封堵即刻左心室容量負(fù)荷加重有關(guān)。
[Abstract]:Background & objective: pulmonary hypertension is a serious disease that endangers human life and health. According to conservative estimates, there are about 13 million patients with pulmonary hypertension in China. Pulmonary hypertension is divided into primary and secondary pulmonary hypertension. Congenital heart disease is a common cause of secondary pulmonary hypertension. Transcatheter closure is a positive and effective way to treat congenital heart disease, slow down or improve pulmonary vascular remodeling and pulmonary hypertension caused by high pulmonary blood flow. It is very important for the success of operation and the improvement of prognosis in patients with congenital heart disease. The plasma brain natriuretic peptide (BNP) is closely related to heart failure, acute coronary syndrome, essential hypertension and other diseases. And related to the degree of pulmonary hypertension, The purpose of this paper is to discuss the changes of plasma BNP concentration and its influence on prognosis after drug therapy and transcatheter closure for patients with congenital heart disease complicated with pulmonary hypertension. Methods: from February 2010 to February 2012, the patients with congenital heart disease in our hospital were studied. Pulmonary arterial systolic pressure 鈮

本文編號(hào)：1635472