The Early Studies Of Alprostadil For Its Curative Effect On Postoperative Of Congenital Heart Disease Combined Pulmonary Hypertention

Objective: Pulmonary hypertension is a pathological coursefeatured as progressive augmentation of pulmonary vascular resistanceand progressive right ventricular failure. It is a common complication ofmany diseases in clinic and mostly second to many diseases of heart andlung. Can also cause unknown, its pathogenesis is not yet fullyunderstood. The most common etiology what can cause pediatricpulmonary hypertension is congenital heart disease, such as ventricularseptal defect(VSD), atrial septal defect (ASD),patent ductusarteriosus(PDA),etc. The prognosis of congenital heart disease combinedpulmonary arterial hypertension is bad if it can not be treated actively.Intravenous application of prostaglandinE1(lipoPGE1) was used inpeople with congenital heart disease combined pulmonary arterialhypertension. According to measure changes such as heart rate, systemicpressure, central venous pressure, pulmonary artery pressure,ejectionfraction,arterial blood oxygen partial pressure before and after the heartoperation on congenital, to observe the effect of prostaglandinE1onhemodynamics in children with pulmonary arterial hypertension (PAH)secondary to congenital heart disease(CHD). To study whetherintravenous prostaglandinE1can selectively lower pulmonary arterypressure and explore an effective way for treatment of PAH secondary tocongenital heart disease.Materials and Methods：1Study population: our research object was forty cases ofcongenital heart disease combined with pulmonary hypertension, whichunderwent surgical treatment in our hospital cardiac surgery from2012 February to2012December. Case selected criteria are:1) age:1month to14years old(14years included);2) diagnosed with left to right shuntcongenital heart disease combined with pulmonary hypertension3)Ultrasonic cardiogram confirmed pulmonary artery systolic pressure﹥40mmHg;4)Dose not exist serious infection status;5)No acid-basebalance, electrolyte disorder, no serious heart, liver and kidney damage.Subgroup: Forty children(age1month to14years)with PAH secondaryto CHD were randomly divided into treatment group(20cases) andconventional group(20cases). The lipid microsphere alprostadil waspumped into central venous after cardiac surgery treatment performed inthe treatment group. Speed for6ng／kg／min,continuous pump point72hours.2Method:After routine preoperative,radial artery piezometer tubeand central venous piezometer tube were placed in all people. Breathingmachine and monitor were connected when returned to the ICU.Mechanical ventilation mode was setted to P-SIMV. tidal volume:6-8ml/kg, respiratory frequency:20-30times per minute, inhaled oxygenconcentration adjusting for arterial blood gas. Monitoring change ofindicators included central venous pressure(CVP),mean arterial bloodpressure(mBP),pulmonary artery pressure(PAP),heart rate(HR),ejectionfraction(EF), arterial blood gas analysis. The monitoring time is beforeand after drug was used. To observe the states and adverse effects of allchildren within24hours after lipid microsphere alprostadiladministration. All dates were measured three times and to calculatemean value by one person in the sane machine.3Statistic method: All statistical analysis was preceded by theapplication of SPSS19.0statistic software. The data was divided intomeasurement data and count data by its nature. Median (inter-quartilerang)(M(Q)) was used to depict the count data, skewed distribution ornon-normal distribution information.The two group and more usenonparametric test (Mann-WhitneU test). Normal distribution material was described with mean and standard deviation. Between differentgroups with t-test analysis. Setting a=0.05, p<0.05for the difference wasstatistically significant.Results:1general information: There were23cases(57.5%) boys and17(42.5%) cases girls in all of the40children. Cardiac malformation wasdivided into19cases(47.5%) with ventricular septal defect,7cases(17.5%) with ventricular septal defect merger patent ductusarteriosus,5cases(12.5%) with patent ductus arterious,4cases(10%)with ventricular septal defect merger interatrial septum defect,1case(2.5%) with double outlet right ventricle,4cases(10%) withinteratrial septum defect merger patent ductus arteriosus. The treatmentgroup and the control group no statistically differences were compared inage, character, pulmonary artery pressure between groups beforesurgery.2Treatment group before and after drug index change was notobvious, that included central venous pressure, mean arterial bloodpressure and heart rate. Index change was not statistically different.TheLVEF increased from58.22±0.84to58.69±0.81;The PO2increasedobviously from110.32±14.02to123.35(102.76,128.93);The pulmonaryartery pressure dropped from50.70±4.96to48.65±4.34. The indexchange statistically significant. In normal group index change was notclear, which include central venous pressure(CVP),mean arterial bloodpressure(mBP), pulmonary artery pressure(PAP), heart rate(HR), ejectionfraction(EF),blood gas analysis. Index change was not statisticallydifferent.Conclusions:1The application of lipid microsphere alprostadil is an effectivemethod that selectively diastolic pulmonary vasodilator for treatment ofpulmonary hypertension, and it can improve eject fraction cardiacfunction. 2Lipid microsphere alprostadil can improve air flow ratio, improvearterial blood oxygen partial pressure.3Lipid microsphere alprostadil can not affect system systemiccirculation and rate, it can not cause hypotension.4No apparent adverse effects were observed in all children, so it isselective for congenital heart disease combined with pulmonary arterialhypertension.