左向右分流先天性心脏病合并三尖瓣反流患儿血流动力学变化及发病机制  

Hemodynamic changes and underlying mechanism of tricuspid regurgitation in neonates with left-to-right shunting congenital heart disease

作　　者：张晓敏[1] 黄丽卿[2] 李性希[2] 陈宇明[1] 高建慧[1] 杨冰岩[1] 周巧云[3] 王维琼[1] 陈少波[1] 

机构地区：[1]南方医科大学附属中山博爱医院,广东省中山市博爱医院新生儿科,528403 [2]南方医科大学附属中山博爱医院,广东省中山市博爱医院医技科,528403 [3]南方医科大学附属中山博爱医院,广东省中山市博爱医院内科,528403

出　　处：《中国小儿急救医学》2007年第6期505-508,共4页Chinese Pediatric Emergency Medicine

基　　金：广东省卫生厅医学科研基金立项课题(编号:A2003874)

摘　　要：目的探讨新生儿左向右分流先天性心脏病(先心病)发生三尖瓣反流(TR)的临床特征和心脏血流动力学变化及TR的发生机制。方法对左向右分流(分流直径≥2 mm)先心病伴TR和不伴TR各52例患儿进行前瞻性对照研究,观察其临床及多普勒超声心动图特征:心腔内径大小、TR最大反流速度、瓣膜反流程度、肺动脉估测压力变化,分析与TR发生有关的影响因素。结果TR组中宫内窘迫、娩出窒息、X线胸片显示心影饱满或增大、心胸比大于0.6、心力衰竭、缺氧心肌损害、二尖瓣反流的发病率比对照组高(P<0.05),前5项因素使TR发生的危险分别增加了3.6、9.3、4.7、3.6、7.5倍。TR组与对照组比较,左、右心房明显增大,肺动脉内径增宽(P<0.05)。52例中,轻度反流37例,中度10例,重度5例,平均反流速度(2.98±0.65)m/s。TR患儿同时存在房、室水平分流的肺动脉估测压>心室(包括导管)水平分流>心房水平分流(P<0.05)。对同时存在房、室水平分流的肺动脉估测压,TR组明显高于对照组(P<0.05)。结论左向右分流先心病发生TR时,表明已存在心脏血流动力学异常,左向右分流使容量负荷增加,肺动脉压升高是形成TR的主要因素,宫内窘迫、娩出窒息、心脏扩大和心力衰竭也是形成TR的重要影响因素。Objective To evaluate the clinical and hemodynamic features of tricuspid regurgitation （TR）in neonates with left-to-right shunting congenital heart disease（including atrial and ventricular septal defect, patent ductus arteriosus）and to investigate underlying mechanism of TR. Methods prospective control study was performed on neonates with left-to-right shunting congenital heart disease identified by Doppler echocardlography, hospitalized during October 2003-July 2006. Fifty-two TR cases and 52 cases without TR were chosen as TR group and control group respectively. The clinical data were collected. Inner ventricular diameter, tricuspid regurgitation velocity （TR-Vmax）, degree of valva regurgitation and pulmonary artery systolic pressure （PASP） were determined by echocardiographic （ECHO） examination. Influencing factors associated with the pathogenesis of TR were analyzed. Results Fetal distress, birth asphyxia, cardiac shadow enlargement in a chest X-ray, heart-chest ratio larger than 0.6, heart failure, myocardial damage caused by hypoxia-isehemia, mitral regurgitation （MR） showed higher incidence in TR group than those in control group （P 〈 0.05）. The odds ratio （OR） of the fetal distress, birth asphyxia, cardiac shadow enlargement in a chest X-ray, heart-chest ratio larger than 0.6, heart failure were 3.6, 9.3, 4.7, 3.6, 7.5 respectively. The inner diameters of atrium and pulmonary artery were larger in TR group than those in control group （P 〈 0.05）. In terms of severity rating among 52 TR cases, 37 eases were mild, 10 moderate and 5 severe. The average velocity of regurgitation was （2.98 ± 0.65） m/s. In TR group, PASP was the most common among neonates with atrial level shunt, and PASP of ventricular level shunt （including patent ductus arteriosus） was higher than that of atrial level shunt （ P 〈 0.05）. PASP with atrial level shunt was higher in TR group than that of control group （P〈 0.05）. Conclusion When TR emerges in neonates with left-to-right

关 键 词：心脏缺损 先天性 三尖瓣闭锁不全 婴儿 新生 超声心动描记术 血流动力学 

分 类 号：R722.1[医药卫生—儿科]