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漂浮导管评估先天性心脏病重度肺动脉高压的作用 被引量:4

Floating catheter evaluates hemodynamics of congenital heart disease with advanced pulmonary hypertension
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摘要 目的研究漂浮导管评估先天性心脏病合并重度肺动脉高压的作用。方法85例先天性心脏病合并重度肺动脉高压患者,男39例,女46例,年龄(22.8±16.5)岁,体重(46.4±12.1)kg,单纯室间隔缺损42例,房间隔缺损11例,室间隔缺损合并动脉导管未闭9例,动脉导管未闭7例,室间隔缺损合并房间隔缺损5例,其他11例。右侧锁骨下静脉或颈内静脉插入漂浮导管,动态监测肺动脉压、评估血流动力学,行急性肺血管反应试验和药物敏感试验。结果与漂浮导管相比超声心动图对重度肺动脉高压诊断符合率差异无统计学意义(98.8%对100%,P〉0.05),评估肺动脉收缩压偏低[(118.2±44.7)mmHg(1mmHg=0.133kPa)对(139.5±32.3)mmHg,P〈0.05,),对艾森门格综合征诊断有较高假阳性率(8.4%对0,P〈0.01)。漂浮导管测定平均肺动脉收缩压/平均肱动脉收缩压值1.22±0.35;平均肺动脉平均压/平均肱动脉平均压值1.07±0.11;肺血管总阻力(17.6±8.3)wood单位,剔除14例艾森门格综合征患者后肺血管总阻力为(11.3±3.7)wood单位,急性肺血管反应试验阳性67例,确诊艾森门格综合征14例。大量双向分流7例。漂浮导管检查中发生穿刺部位血肿2例。结论漂浮导管检查评估肺动脉高压的程度、性质和血流动力学情况安全、准确,同时可进行急性肺血管反应试验和药物敏感试验,可为制定先天性心脏病合并重度肺动脉高压治疗方案提供客观依据。 Objective It is still controversial how to deal with the congenital heart disease with advanced pulmonary hy- pertension. The choices of treatment for these patients must depend on the character and degree of pulmonary vascular change. The pulmonary vascular change correlates well with hemodynamics and acute pulmonary vasoreactivity test. Therefore, it will play an important role to obtain accurately these evaluations. Methods This paper studies 85 cases (38 males and 46 females) with congenital heart disease complicated with advanced pulmonary hypertension and bidirectional shunt, which are diagnosed by echocardiography. Whose age range is (22.8 ± 16.5 ) and weight range (46.4 ± 12.1 ) kg. Among those cases ,42 are VSD, 11 are ASD ,9 are VSD with patent ductus arteriosu ,7 arc patent ductus arteriosu ,5 are ASD with VSD, and 11 are the others. With congenital heart disease complicated with advanced pulmonary hypertension and bidirectional shunt, which are diagnosed by echocardiography. There were floating catheter retention of 4 to 13 days ( average 7.5 days). Through the right subclavian vein or jugular vein, floating catheter is inserted into pulmonary artery. Pulmonary artery pressure is recorded continu- ously and analyzed. Hemodynamics, acute pulmonary vasoreactivity test and drug sensitivity test are evaluated. Differences of the hemodynamics are analyzed between echocardiography and floating catheter examination. Results Compared with floating catheter examination, there are not significantly difference for the diagnosis of advanced pulmonary hypertension (98.8% vs. 100% , P 〉0.05), less accurately diagnosis (64.3% vs. 100% ,P 〈0.05) and higher IIfalse positive rate(8.4% vs. 0, P 〈 0.05 ) for Eisenmenger syndrome in echocardiography examination. Floating catheter examination shows that mean systolic pulmonary artery pressure( PAP)/mean systolic body artery blood pressure (BP) and mean PAP / mean BP were equal to 1.22 ±0.35 and 1.07 ±0.11 respectively. The patients presented total pulmonary vascular resistance of (17.6 ± 8.3 ) Wood units. Bidirectional shunt volume is more than 30% cardiac outputs in 7 cases. Apart from 14 cases with Eisenmenger syndrome, total pulmonary vascular resistance is ( 11.3 ± 3.7 ) Wood units. Acute pulmonary vasoreactivity test presents positive in 67 cases. After drug sensitivity test, 14 cases with Eisenmenger syndrome underwent medical treatment and waited lung transplantation or heart-lung transplantation. Floating catheter examination happened hematoma(2/85 ) in 2 patients. 71 cases underwent surgical treatment. Operative complications included right heart failure (6/71) and pulmonary infection (5/71 ).Operative mortality was 5.6% (4/71). The main causes of death were right heart failure. Compared with preoperative arterial oxygen saturation, postoperative arterial oxygen saturation increased by (9.7 ± 4.1 ) % ( P 〈 0.05 ). Conclusion Floating catheter examination can evaluate accurately pulmonary hypertension, hemodynamics, acute pulmonary, vasoreactivity test, drug sensitivity test and bidirectional shunt volume. All the patients, who were diagnosed as advanced pulmonary hypertension with bidirectional shunt by echocardiography, should undergo floating catheterization. Floating catheter examination can provide reliable, objective theoretical basis for the choice of treatment in the congenital heart diseases with advanced pulmonary hypertension.
出处 《中华胸心血管外科杂志》 CSCD 北大核心 2012年第8期488-491,共4页 Chinese Journal of Thoracic and Cardiovascular Surgery
关键词 心脏缺损 先天性 肺动脉高压 漂浮导管检查 超声心动图 Heart defects, congenital Pulmonary hypertension Catheterization Echocardiography
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参考文献11

  • 1柳志红,王勇,张洪亮.急性血管反应试验用于肺动脉高压的诊断[J].中国实用内科杂志,2010,30(12):1083-1084. 被引量:3
  • 2Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagno- sis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) , endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J, 2009, 30:2493-2537.
  • 3邝土光,王辰,庞宝森,王军,翟振国.超声检查在肺动脉高压诊疗中可靠性的Meta-分析[J].心肺血管病杂志,2007,26(3):149-151. 被引量:16
  • 4Giglia TM, Humpl T. Preoperative pulmonary hemodynamics and as- sessment of operability: is there a pulmonary vascular resistance that precludes cardiac operation?. Pediatr Crit Care Med, 2010,11 (2 Suppl) :S57-S69.
  • 5Viswanathan S, Kumar RK. Assessment of operability of congenital cardiac shunts with increased pulmonary vascular resistance. Catheter Cardiovasc Interv, 2008, 71:665-670.
  • 6周敬群,尹薇,曹林生.肺动脉高压457例患者右心导管检查死亡13例分析[J].中国医学影像技术,2000,16(11):973-974. 被引量:3
  • 7邢建洲,李莉,袁晓东,王晓伟,陈岭,王戈.经右锁骨上锁骨下静脉路径进行紧急床边心脏起搏[J].第二军医大学学报,2011,32(7):804-805. 被引量:2
  • 8Gaine SP, Rubin LJ. Primary pulmonary hypertension. Lancet, 1998, 352 : 719-725.
  • 9Chin KM, Kim NH, Rubin LJ. The right ventricle in pulmonary hy- pertension. Coron Artery Dis, 2005,16 : 13-18.
  • 10Howard LS. Prognostic factors in pulmonary arterial hypertension : assessing the course of the disease. Eur Respir Rev, 2011, 20: 236-242.

二级参考文献33

  • 1高莹,崔大山,周维新,李永顺,柳志红,何建国,张海涛.41例闭塞性肺动脉高压患者应用多普勒超声心动图法与右心导管法测定肺动脉压力的比较[J].中国循环杂志,2004,19(3):216-218. 被引量:13
  • 2徐勇.Meta分析常见资料类型及统计分析方法[J].中华预防医学杂志,1994,28(5):303-307. 被引量:66
  • 3丁士芳,李继福,王树春,黎丽,李贵双,陈玉国,鹿庆华,纪求尚,刘同涛.原发性肺动脉高压(附11例报告)[J].临床心血管病杂志,1996,12(4):225-227. 被引量:2
  • 4危小军,廖伟,钟一鸣,廖祥中,谢东明,王小萍,谢东阳.床旁紧急临时心脏起搏治疗严重缓慢性心律失常疗效及安全性评价[J].临床荟萃,2007,22(3):182-183. 被引量:6
  • 5Galie N, Hoeper MM, Humbert M, et al. Guidelines for the diagno- sis and treatment of pulmonary hypertension:The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the Eu- ropean Society of Cardiology (ESC) and the European Respiratory Society (ERS) ,endorsed by the International Society of Heart and Lung Transplantation (ISHLT) [ J ]. Eur Heart J, 2009, 30, 2493 - 2537.
  • 6Weir EK, Rubin LJ, Ayres SM, et al. The acute administration of vasodilaton in primary pulmonary hypertension. Experience from the National Institutes of Health Registry on Primary Pulmonary Hypertension[ J]. Am Rev Respir Dir, 1989,140 : 1623 - 1630.
  • 7Packer M. Is it ethical to administer vasodilator drags to patients with primary pulmonary hypertension? [ J]. Chest, 1989, 95: 1173 -1174.
  • 8Galie N, Torbicki A. Barst R, et al. Guidelines on diagnosis and treatment of puhnonary arterial hypertension [ J ]. Eur Heart J, 2004,25,2243 - 2278.
  • 9Galie N, Ussia G, Passarelli P, et al. Role of pharmacologic tests in the treatment of primary puhnonary hypertension[ J ]. Am J Cardi- ol, 1995,75:55A - 62A.
  • 10Opitz CF,Wensel R,bettnmnn M, et al. Assessment of the vasodi- lator response in primary pulmonary hypertension. Comparing pros- tacyclin and iloprost administered by either infusion or inhalation [ J ]. Eur Heart J ,2003,24:356 - 365.

共引文献19

同被引文献21

  • 1李媛,张军辉,曹礼庭,顾鹏,魏锦,罗文峰,张青,张敏惠,蒋冰蕾.超声心动图评价系统性硬化病肺动脉高压的临床研究[J].中华医学超声杂志(电子版),2011,8(10):2135-2140. 被引量:3
  • 2刘铭,杨康,曾会昌,廖克龙,王明荣,唐令凤,张玉霞.46例成人继发孔房间隔缺损合并肺动脉高压的外科治疗经验[J].第三军医大学学报,2005,27(24):2464-2466. 被引量:6
  • 3汪晓云.中国医师协会循证医学委员会肺动脉高压诊治专家共识(草案)[C]//贵州医学会心血管病分会、心电生理与起搏学分会2008年学术年会专题讲座及论文摘要汇编,2008:172-174.
  • 4SWAN H,GANZ W,F O RRESTER J.Catheterigation of the heart in man with use of a flow-directed balloon-tipped catheter[J].N Engl J Med,1970,283:447-451.
  • 5ROUNTREE W D.Removal of pulmonary artery catheters by regisered nurses:A study and complications[J].Focus On Critical Care,1991,18(4):313-318.
  • 6杨煜.漂浮导管监测在心脏外科术后的应用及护理[J].中国实用护理杂志,2011,27(7)增刊:91-92.
  • 7Thilen U ,Berlind S ,Vamauskas E .Atrial septal defect in adults:thirty- eight-year follow-up of a surgically and a conservatively man aged group.ScandC ardiovas J ,2000,34:79,83.
  • 8Attie F ,IKosas M , Grartados N ,et al.Surgical treatment for secundum atrial septal defects in patients>40years old:a randomized clinical trial. J Am CoU Cardio1,2001,38:2035-2042.
  • 9Gatzouils MA,Redington AN,Somervile J ,et al.Shoulda trial septal defect in adults be closed?Ann Thorac Surg,1996,6:657-659.
  • 10童晓明,霍晓光,王涛,闫鑫,张秀明,赵云鹤.超声心动图对肺动脉高压和肺静脉高压的非侵入性鉴别诊断研究[J].中华超声影像学杂志,2010(7):569-571. 被引量:1

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