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