无创伤肺血管阻力估测法在二期Fontan术术前肺血管评价中的应用  

Noninvasive preoperative estimation of pulmonary vascular resistance of the patients waiting for two staged Fontan procedure two

作　　者：黄美蓉[1] 陈树宝[1] 高伟[1] 李奋[1] 李筠[1] 杨健萍 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,200127

出　　处：《中华儿科杂志》2008年第4期267-271,共5页Chinese Journal of Pediatrics

摘　　要：目的采用无创伤肺血管阻力评价方法，观察二期Fontan术术前肺血管阻力（PVR）估计值与手术预后的关系。方法选择33例施行二期Fontan手术的患儿，根据术前血红蛋白（HGB）、红细胞比容（HCT）、经皮氧饱和度（SpO2）计算PVR估计值。按PVR估计值〈2．4wood、2．4～3．2wood和〉3．2wood单位分成低危、高危和极高危3组，观察术后严重低心排和多脏器功能衰竭的发生率；同时按手术后是否出现严重低心排和多脏器功能衰竭分成2组，未出现者为甲组，出现者为乙组，观察2组间术前HGB、HCT、SpO2和PVR估计值的差异。结果根据PVR估计值分成的低危、高危和极高危3组患儿，术后严重低心排和多脏器功能衰竭的平均发生率分别为10．0％、32．4％和63．6％，差异有统计学意义（P〈0．01）；根据手术后是否出现严重低心排和多脏器功能衰竭的两组患儿，术前HGB、HCT、SpO：和PVR均有显著差异，其中，PVR（HGB）甲组为（2．53±0．56），乙组为（3．24±0．58），PVR（HCT）甲组为（2．59±0．58），乙组为（3．21±0．79），PVR（Sp02）甲组为（2．22±0．55），乙组为（2．93±0．58），差异均有统计学意义（t=3．25、2．52、3．33，P〈0．01或0．05）。结论无创伤方法计算的PVR估计值与手术后的多脏器功能不全的发生概率相吻合，故可作为评价二期Fontan手术指征和估计预后的方法。Objective Noninvasive method for estimating the pulmonary vascular resistance （PVR） was used in patients waiting for two staged Fontan procedure to observe the relationship between estimated PVR and surgical results. Methods Thirty-three candidate patients for two staged Fontan procedures were randomly selected for this trial. Preoperative hemoglobin （HGB）, hematocrit （HCT） and pulse oxygen saturation （SpO2 ） were measured. Estimated PVRs were then calculated by the regression equations. The cases were divided into three groups of low risk group with PVR less than 2.4 wood, high risk group with PVR between 2. 4 to 3.2 wood, and extremely high risk group with PVR more than 3.2 wood. The incidences of postoperative low cardiac output and multi-organ failure were compared. Simultaneously, the cases without or with postoperative severe low cardiac output and multi-organ failure after operation were divided into two groups. The preoperative HGB, HCT and estimated PVR among the groups were analyzed. Results The rates of postoperative severe low cardiac output and multi-organ failure were 10. 0%, 32. 4% and 63.6% for the patients of low , high and extremely high risk groups respectively. The difference was significant （P 〈 0. 01 ）. The preoperative HGB, HCT, SpO2 and PVR were all significantly different between the patients without or with postoperative severe low cardiac output and multi-organ failure. The PVR （HGB） were （2. 53 ± 0. 56） wood and （3.24 ± 0. 58 ） wood respectively. The PVR （HCT） were （2. 59 ± 0. 58 ） wood and （ 3.21 ± 0. 79 ） wood respectively. The PVR（ SpO2 ） were （ 2. 22 ± 0. 55 ） wood and （ 2. 93 ± 0. 58） wood, respectively. The differences were all significant （ t = 3.25, 2. 52 and 3.33 respectively, P〈0.01 or0.05）. Conclusions Preoperative estimated PVRs calculated by HGB, HCT and SpO2 were comparable with the postoperative results. Thus, the invasive preoperative estimation of pulmonary vascular resistance could be a method in es

关 键 词：心血管畸形 FONTAN手术 血管阻力 

分 类 号：R686[医药卫生—骨科学]