先天性心脏病伴肺动脉高压患者肺血管反应性的判断  

A clinical study on assessment of pulmonary vasoreactivity in congenital heart disease patients with pulmonary hypertension

作　　者：李冰冰[1] 姜桢[2] 王春生[3] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,南京市210008 [2]上海市复旦大学附属中山医院麻醉科 [3]上海市复旦大学附属中山医院心外科

出　　处：《临床麻醉学杂志》2009年第8期649-651,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨先天性心脏病伴严重肺动脉高压(PH)患者肺血管反应性的判断标准。方法20例伴严重PH的先天性心脏病患者行急性肺血管扩张试验,采用不同的指标判断肺血管反应性,并进行肺血管病理评估和平滑肌α-肌动蛋白免疫组化检测。结果以FICK法原则计算所得肺血管阻力/体循环阻力(PVR/SVR)值下降超过20%作为阳性标准,比目前通用的判断标准进一步提高了肺血管扩张试验的阳性率。肺血管扩张试验阴性的患者较阳性患者肺血管病理损伤严重,并伴有平滑肌α-肌动蛋白表达升高。结论采用PVR/SVR作为肺血管反应性指标,比目前标准能更加可靠预测肺血管阻力的可逆程度,对先天性心脏病伴严重PH患者手术指征的判断具有重要的参考价值。Objective To study the criteria for evaluating pulmonary vascular reactivity in congenital heart disease （CHD） patients with pulmonary hypertension （PH）. Methods Pulmonary vasculature reactivity was evaluated with two different criteria in 20 CHD patients with severe PH scheduled for acute pulmonary vasodilator testing. Pulmonary vascular pathologic lesion assessment was performed and expression of α-actin protein in smooth muscles was detected by immunohistochemistry stain in patients underwent surgery. Results Compared with the present criteria commonly used, the postive reaction to pulmonary vasodilator testing was significantly increased by the criteria of 20% decrease in pulmonary vascular resistance/systemic vascuar resistance （PVR/SVR） according to FICK principle with no reduction in cardiac output. The pulmonary vascular pathologic scale （Heath-Ewards） ranked higher, accompanied with increased α-acting protein expression of smooth muscles in pulmonary precapillary arterioles in the patients with negative reaction to pulmonary vasodilator testing, compared with those with positive reaction. Conclusion The value of PVR/SVR inferred from formula according to FICK principle may be more reliable in predicting the reversibility of pulmonary vascular resistance, which has an important role in the assessment of surgical indications for CHD patients with PH.

关 键 词：先天性心脏病 肺动脉高压 

分 类 号：R614[医药卫生—麻醉学]