【摘要】 目的：了解卡托普利对左向右分流先天性心脏病肺动脉高压患者的血液动力学影响。方法：心内左向右分流肺动脉平均压＞ ２７ ｋ Ｐａ 的患者３０ 例，卡托普利０４ ～０６ ｍｇ／ｋｇ（ ≯１２５ ｍｇ） ，每日３ 次，服药前及３ ～５ ｄ 后用多普勒超声心动图观察血液动力学指标。结果：发现用药后出现两种不同的血液动力学变化，肺／ 体循环总阻力比值（ Ｔ Ｐ Ｒ／ Ｔ Ｓ Ｒ） 较低的 Ａ 组用药后主动脉压及体循环总阻力下降，肺动脉压及肺总阻力不变， Ｔ Ｐ Ｒ／ Ｔ Ｓ Ｒ 升高，肺／ 体循环血流量比值（ Ｑｐ／ Ｑｓ） 减少；而 Ｔ Ｐ Ｒ／ Ｔ Ｓ Ｒ较高的 Ｂ 组主动脉及肺动脉压均降低，体循环总阻力无明显变化，肺总阻力降低， Ｔ Ｐ Ｒ／ Ｔ Ｓ Ｒ 下降， Ｑｐ／ Ｑｓ 增高。临床上 Ａ 组比 Ｂ组症状改善更明显。结论：卡托普利降低先天性心脏病患者肺动脉压的同时，有可能出现 Ｑｐ／ Ｑｓ 增加这一不利的血液动力学变化。应将 Ｑｐ／ Ｑｓ 列为常规观察指标之一，特别是对于大分流量有症状的患者。更多还原

【Abstract】 Objective : To evaluate the hemodynamic responses of captopril on pulmonary hypertension secondary toleft to right shunt congenital heart diseases . Method : Hemodynamic data of 30 patients with intracardiac left to rightshunt and pulmonary artery mean pressure > 2 7 k Pa were measured by doppler echocardiography before and after 0 4 ～0 6 mg/kg( ≯12 5 mg) of oral captopril was given three times daily . Results : In the group Awith relatively lowertotalpulmonary to systemic resistance ratio ( T P R/ T S R) ,aortic mean pressure ( A M P) and T P Rdid not change significantly , T P R/ T S Rraised and pulmonary to systemicflow ratio( Qp/ Qs) reduced . In the group Bwith relatively heigher T P R/ T S Rration , A M Pand P A M Pdecreased , T P Rreduced , T S Rdid not change , T P R/ T S Rdecreased and Qp/ Qsincreased . Theclinical improvementin group A was better than that in group B. Conclusion : When captoprill decreases the pulmonaryartery pressure in the patients with congenital heart disease , Qp/ Qs may increase atthe same time , which is not good tothese patients . We belive Qp/ Qs should be observed in this kind of patients especially with large left to right shunt asso ciated with clinical symptoms , when captoprill is used .更多还原