先天性心脏病合并肺动脉高压患者可手术性分析

先天性心脏病合并肺动脉高压患者可手术性分析

王晓峰;顾虹;张陈;吴邦骏;郭保静;张辉;程沛;刘迎龙

【期刊名称】《中国医药》 【年(卷),期】2012(007)004

【摘要】Objective To analyze the operability in patients with severe pulmonary hypertension (PAH)related to congenial heart disease (CHD).Methods From June 2006 to October 2010,the clinical data of 30 patients who experienced total rerpair were retrospectively analyzed.All of them had preoperative cardiac catheterization and acute pulmonary vasodilator testing with 100％ oxygen and inhaled Iloprost respectively.According to the postoperative recovery (whether postoperative mean pulmonary pressure ≥25 mm Hg),patients were separated into two groups:normal pulmonary pressure group and PAH group.The preoperative clinical data between the two groups and the receiver operating characteristic curve were analyzed to find the data related to the operability.Results There was no deaths after operations.Group 1 (postoperative mean pulmonary pressure ＜ 25 mm Hg)contained 12 patients and group 2 (postoperative mean pulmonary pressure ≥25 mm Hg) contained 18 patients.Between the two groups,the cardiothoracic ratio (CTR) [ (0.67 ± 0.06) vs (0.55 ± 0.06) ] on chest X-ray; pulmonary vascular resistance index (PVRi) [ (7.6 ±3.2)wood unit/m2 vs ( 13.0 ±4.5)wood unit/m2] at baseline; pulmonary/systemic

circulation blood flow ratio(Qp/Qs) and PVRi at acute pulmonary vasodilator testing with 100％ oxygen [ Qp/Qs:5.6 ± 3.5 vs2.7 ± 0.8,PVRi:( 3.0 ± 1.8 ) wood unit/m2 vs ( 6.4 ± 2.2) wood unit/m2 ] ; Qp/Qs ; PVRi and pulmonary/systemic circulation resistance ratio(Rp/Rs) at vasodilator testing with inhaled iloprost [ Qp/Qs:4.1 ± 2.4 vs 2.0 ± 1.3,PVRi:(4.3 ±3.0) wood unit/m2 vs (8.3 ±3.1 )wood unit/m2,Rp/Rs:0.2 ±0.2 vs 0.4 ±0.2]all showed statistical significances (P ＜ 0.05).The ROC curve indicated that CTR was most sensitive and PRVi at acute pulmonary vasodilator testing with 100％ oxygenand inhaled iloprost was most accurate. CTR more than 0.615,PVRi at vasodilator testing with 100％ oxygen less than 4.22 wood unit/m2,PVRi at vasodilator testing with inhaled iloprost less than 4.915 wood unit · m2 may predict good short term postoperative prognosis.Conclusion The CTR and PVRi at acute pulmonary vasodilator testing with 100％ oxygen and inhaled iloprost help analyze the operability in patients with severe PAH related to CHD.%目的 分析先天性心脏病(CHD)合并重度肺动脉高压(PAH)患者的可手术性.方法 回顾性分析2006年6月至2010年10月接受根治手术的30例患者.所有患者接受术前心导管检查并分别吸入100％氧气和伊洛前列素(Iloprost)行急性肺血管扩张试验.根据患者术后是否残存PAH将患者分为肺动脉压力正常组和PAH组.对2组患者的术前检查项目进行观察,用受试者工作特征(ROC)曲线分析可手术性.结果 患者术后全部存活.2组(肺动脉压力正常组和PAH组)患者的术前检查中,胸部X线片心胸比(CTR),心导管检查中基础状态肺

小动脉阻力指数(PVRi),吸入100％氧气行急性肺血管扩张试验后肺体循环血流比(Qp/Qs)和PVRi,吸入Iloprost行急性肺血管扩张试验后Qp/Qs,PVRi和肺体循环阻力比(Rp/Rs)差异均有统计学意义[ CTR:(0.67±0.06)比(0.55±0.06),基础状态PVRi:(7.6±3.2) wood unit/m2比( 13.0 ±4.5)wood unit/m2；吸入100％氧气后Qp/Qs:5.6 ±3.5比2.7±0.8,PVRi:( 3.0±1.8) wood unit/m2比( 6.4±2.2)wood unit/m2；吸入Iloprost后Qp/Qs:4.1 ±2.4比2.0±1.3,PVRi:(4.3±3.0)

wood

unit/m2

比

(

8.3±3.1)wood

unit/m2,Rp/Rs:0.2 ±0.2比0.4±0.2,均P＜0.05].ROC曲线提示CTR敏感性最高(敏感度0.923),吸入100％氧气后PVRi及Iloprost行急性肺血管扩张试验后PVRi准确性最高(准确度均为0.889);CTR高于0.615,吸入100％氧气后PVRi低于4.22wood unit/m2,吸入Ilprost后PVRi低于4.915wood unit/m2的患者短期手术预后较好.结论 CTR、吸入100％氧气及Iloprost行急性肺血管扩张试验后PVRi这几项检查更适合判断CHD合并重度PAH患者的可手术性.

【总页数】3页(449-451)

【关键词】心脏缺损,先天性;高血压,肺性;心脏导管插入术;手术 【作者】王晓峰;顾虹;张陈;吴邦骏;郭保静;张辉;程沛;刘迎龙

【作者单位】100029 首都医科大学附属北京安贞医院小儿心脏科;首都医科大学;100029 首都医科大学附属北京安贞医院小儿心脏科;100029 首都医科大学附属北京安贞医院小儿心脏科;100029 首都医科大学附属北京安贞医院小儿心脏科;100029 首都医科大学附属北京安贞医院小儿心脏科;100029 首都医科大学附属北京安贞医院小儿心脏科;100029 首都医科大学附属北京安贞医院