Clinical Research On Volume Control By Measuring Left Atrial Pressure In Patients With Ventricular Septal Defect And Pulmonary Hypertension During Operation

There is a big individual difference in postoperative treatment for patientswith ventricular septal defect with pulmonary hypertension, mainly reflectedin whether postoperative systemic pulmonary circulation volume load matchleft and right ventricular function. Single use of conventional central venouspressure (CVP) monitoring could roughly evaluate the capacity of theload,may not accurately reflect the right heart-pulmonary circulation–the leftheart functional state of every link in the chain, making intraoperative andpostoperative treatment for critically ill patients mainly rely on a lot ofexperience, test and speculation, the assessment of the patient’s condition isprone to error.Within a certain extent and scope, monitoring of left atrialpressure (LAP) can identify each link in the chain of right ventricle-pulmonary circulation-left ventricular state, this make up for a single centralvenous pressure (CVP) monitoring. The aim of the reasearch is to analysisIntraoperative and post-operative left atrial pressure (LAP) and central venouspressure (CVP) level by establishing a safe path to the left atrial pressuremeasurement,combined with systemic circulation pressure and urine volumeand blood gas analysis and other index to guide regulation of the activevascular drugs and judgment of the preload of the left and right heart,in orderto achieve a more accurate therapeutic purposes, so that the perioperation ofthe patients should be smooth,the patient’s postoperative recovery improvedand survival rate increased, which is clinical significant.Objective: The aim of the study is to observe the trends of septal defectwith pulmonary hypertension patients’ left atrial pressure (LAP) and centralvenous pressure (CVP) after cardiopulmonary bypass (CPB) shutdown,andfind the pulmonary arterial hypertension on left atrial pressure (LAP) and central venous pressure (CVP) variation of the impact,and the recovery of leftand right cardiac function.And to further evidence the accuracy of the basedleft atrial pressure (LAP) and more effective guidance of vasoactive drugs byrapid infusion test.Methods: Clinical data of20patients of surgical treatment forventricular septal defect with pulmonary hypertension and only ventricularseptal defect in The Second Hospital of Hebei Medical University from July2013to March2014was Collected, The changes of the left atrial pressure(LAP) and central venous pressure (CVP) after CPB shutdown in24hourswas recorded and compared during rapid infusion after cardiopulmonarybypass (CPB). The patients were divided into two groups, the experimentalgroup are patients with ventricular septal defect with pulmonary hypertension,the control group are patients with only ventricular septal defect. Ten cases ofventricular septal defect with pulmonary hypertension patients were includedin The experimental group,in which there are four cases of male patients andsix cases of female patients,ASA physical status Ⅰ-Ⅲ,the average age was16±5years old, PH was70±33mmHg, septal echo loss was12±6mm, EF%to67±6%, CO was7±3/L, pulmonary artery/aorta was1.5-2:1,cardiothoracic ratio was0.60±0.08, CPB time was80±16min, blocking timewas46±19min, anesthesia time was293±62min. The control groupconsisted of ten cases of patients with ventricular septal defection, two casesof male patients and eight cases of female patients were included, ASAphysical status Ⅰ-Ⅱ, the average age was15±6years old, septal echo losswas5.6±2.3mm, EF%to63.4±2.4%, CO was4.2±1.3/L, pulmonary/aortic1:1, cardiothoracic ratio was0.57±0.05, CPB time was64±23min,blocking time was33±18min, anesthesia time was259±42min. Rapid infusion experiment based on the patient’s weights, supply10ml/kg blood tocardiopulmonary bypass machine through pressure input to the patient.Results: LAP and CVP and difference between them were observed afterCPB shutdown, In the experimental group-ventricular septal defect withpulmonary hypertension group CVP>LAP, the significan difference between the LAP and CVP changes were statistically significant (P <0.05), reachedconsensus within6-12hours, then CVP could be used to evaluate the leftventricular function instead of LAP. In the control group-simple ventricularseptal defect group the difference between the LAP and CVP change was notstatistically significant (P>0.05), CVP and LAP correlated well within thenormal range. In rapid infusion test after CPB shutdown, In the experimentalgroup-ventricular septal defect with pulmonary hypertension group LAP andCVP changes were statistically significant (P <0.05), LAP increased morethan CVP; In the control group-simple ventricular septal defect group, LAPand CVP change was not statistically significant (P>0.05), because LAP andCVP consistent increased in magnitude.Conclusions: Patients of ventricular septal defect with pulmonaryhypertension underwent repair of ventricular septal defect, left atrialpressure can guide the volume control and the use of vasoactive in thepostoperative. Pulmonary hypertension can affect the relationship betweenLAP and CVP in a certain time.