心外管道全腔静脉肺动脉连接术后5年的肺血管发育  

The study of pulmonary arterial development in patients after 5 years of extracardiac tota cavopulmonary connection

作　　者：王辉山[1] 尹宗涛[1] 汪曾炜[1] 朱洪玉[1] 方敏华[1] 

机构地区：[1]沈阳军区总医院心血管外科,110016

出　　处：《中华胸心血管外科杂志》2012年第1期16-19,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：全军十一五科研基金资助（06Q015）

摘　　要：目的采用放射性核素显像及肺动脉造影分析心外管道全腔静脉肺动脉连接（cxtracardiac total cavopulmonary connection，ETCPC）术后5年肺血管发育的演变情况。方法43例ETCPC患者，通过右心导管及肺动脉造影计算术后早期及术后5年的肺动脉指数（pulmonary arterial index，PAI）、肺小血管阻力（pulmonary vascular resistance，PVR），测量腔静脉压（central venous pressure，CVP）及动脉血氧饱和度（arterial oxygenation saturation，SatO2％），应用放射性核素显像计算术后患者肺血灌注量，观察术后肺血管发育。结果随访期指标与术后早期相比，PAI显著增加（t=2．41，P＜0．05），PVR显著下降（t=2．08，P＜0．05），CVP显著下降（t=2．69，P＜0．05），SatO：％差异无统计学意义。放射性核素肺灌注检查显示，与术后早期比较，随访期肺总核素计数值及右肺／左肺灌注比值差异无统计学意义（t=0．38，P＞0．05及t=1．12，P＞0．05），全肺上段／下段比值显著下降（t=2．54，P＜0．05）。结论Fontan循环的弱搏动血流仍可推动肺血管的继续发育，但术后中期肺血管阻力下降不会导致肺血灌注量及氧供的增加，可能与肺动静脉短路大量形成有关。Objective To study the pulmonary arterial development over five years in patients underwent extracardiac total eavopulmonary connection （ETCPC）. Methods 43 survived patients who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation. Central venous pressure （CVP） and arterial oxygenation saturation （SatO2 % ） were measured by right cardiac catheter, pulmonary arterial index （PAl） and pulmonary vascular resistance （PVR） were calculated. Pulmonary blood distribution were measured and calculated by 99m Te-MAA perfusion imaging. Results The PAI and PVR of the follow-up group reduced significantly （ t =2.41,P〈0.05; t =2.08, P〈0.05） , CVP also reduced significantly （ t = 2.69, P 〈 0.05 ）, but SatO2 % did not changed significantly. Total radionuelide counts and the ratio of rightorleft pulmonary perfusion did not change significantly. （ t = 0.38, P 〉 0.05 ; t = 1.12, P 〉 0.05 ） , but the ratio of the superior and inferior lobe decreased significantly （ t = 2.54, P 〈 0.05 ）. Conclusion The weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development. However, the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply, which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.

关 键 词：心脏缺损 先天性 右心转流术 肺动脉 血管阻力 放射性核素血管显像 术 心血管造影术 数字减影 

分 类 号：R654.3[医药卫生—外科学]