The perioperative application of using norepinephrine through the catheterization of left atrium in patients of congenital heart disease with sever pulmonary arteries hypertension

Abstract

Objective To evaluate the curative effects of using norepinephrine through the catheterization of left atrium in patients of congenital heart disease with sever pulmonary arteries hypertension (SPAH) during perioperative period.Methods Forty pediatric patients of both sexes scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly diveded into 2 groups(n =20 each):control group (C group) and transfusing the norepinephrine through the catheterization of left atrium group (L group).After the cardiac resuscitation,C and L groups were continuous given infusion of dopamine,dobutamine,epinephrine,nitroglycerin and at the same time the L group were transfused the norepinephrine through the catheterization of left atrium.The hemodynamic parameters,blood lactate values of each group at parallel loop (T1),15 min after CPB shutdown (T2),end of the surgery (T3),24 h after the surgery (T4) were recorded.The main and pulmonary artery pressure inversion rate of the patients,the incidence of right heart failure,duration of mechanical ventilation and duration of stay in intensive care unit,the the incidence of postoperative pulmonary complications,mortality were also recorded.Results In group C and L,the main and pulmonary artery pressure inversion rate of the patients were 55％ and 5％,the incidence of right heart failure were 80％ and 5％,the duration of mechanical ventilation were (123.00 ± 13.50) h and (76.00 ±7.25) h,the duration of stay in intensive care unit were (8.00 ± 1.60) d and (5.00 ± 0.70) d,the incidence of postoperative pulmonary complications were 70％ and 10％,and the mortality were 10％ and 0％.Compared with C group,the results of group L were much belower (P ＜ 0.05).Conclusion The therapeutic idea that using norepinephrine through the catheterization of left atrium to maintain adequate cardiac output and peripheral vascular resistance is superior for postoperative complications and mortality reduction in patients of congenital heart disease with SPAH after operation. Key words: Catheterization; Left atrium ; Norepinephrine ; Congenital heart disease; Pulmonary arteries hypertension