主动脉缩窄矫治术后血管结构与功能的随访研究  

Follow-up for vascular structure and function in children with successfully repaired coarctation of aorta

作　　者：曾洁敏[1] 黄萍[1] 王红英[2] 袁家[1] 陈欣欣[1] 崔虎军[1] 冯浩然[3] 崔彦芹[1] 李建斌[1] 金丽玲[4] 

机构地区：[1]广州医学院附属广州市妇女儿童医疗中心心脏中心,510623 [2]广州医学院附属广州市妇女儿童医疗中心超声科,510623 [3]广州医学院附属广州市妇女儿童医疗中心实验室,510623 [4]广州医学院附属广州市妇女儿童医疗中心外科,510623

出　　处：《中华胸心血管外科杂志》2012年第7期421-424,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨主动脉缩窄矫治术后近、中期血管结构与功能改变。方法选取20例确诊主动脉缩窄（CoA）并行手术矫治的患儿（CoA组），其中单纯性主动脉缩窄6例，复合性主动脉缩窄（合并其他心内畸形）14例；同期20例单纯室间隔缺损（VSD）患儿（VSD组）作对照，均于术前至术后1年监测血压，超声下颈总动脉内中膜厚度（IMT）和肱动脉血流介导的血管舒张功能（FMD）。20例健康儿童（健康组）进行1年的随访。结果术前、术后1个月、术后6个月、术后1年3组均无高血压临床表现。CoA组的颈总动脉IMT[（0．47±0．10）mm、（0．49±0．10）mm、（0．57±0．07）mm、（0．61±0．07）mm]均高于同期的VSD组[（0．41±0．11）mm，（0．43±0．11）mm，（0．51±0．08）mm，（0．55±0．08）mm]与健康组[（0．40±0．09）mm、（0．42±0．11）mm、（0．50±0．08）mm、（0．57±0．08）mm]，差异均有统计学意义，P〈0．05。CoA组的肱动脉FMD[（5．46±1．51）％、（5．71±1．88）％、（5．42±1．69）％、（5．27±1．02）％]均明显低于VSD组[（6．69±1．45）％、（6．66±1．21）％、（6．81±1．03）％、（6．43±1．34）％]和健康组[（6．59±1．84）％，（6．84±1．41）％、（6．91±1．31）％、（6．56±1．62）％]，差异均有统计学意义，P〈0．05。而上述两个指标在VSD组与健康组之间均差异无统计学意义，P〉0．05。结论主动脉缩窄矫治术后患儿仍存在血管结构和内皮功能异常，提示手术纠治主动脉缩窄后血管损害持续存在，可能是主动脉缩窄矫治术后患儿心血管疾病发生率高于健康儿童的原因。Objective Even after successful surgical repair, patients with coarctation of the aorta （CoA） are at high risk of long-term morbidity and mortality due to cardiovascular events, which is probably related to persistent arterial disfunction during long-term follow-up after operation. The aim of the study was to explore the alterations of vascular structure and function in children with successfully repaired CoA in the short- and mid-term follow-up. Methods A cohort of 20 children who under- went CoA repair between January 2010 and October 2010 in Guangzbeu women and children＇s Medical Center was studied. There were 14 males and 6 females in CoA group, which comprised 6 patients with isolated CoA, 14 patients with CoA associat- ed with intracardia anomalies, whose median age of operation was 4 months （rang from 1 month to 10.0 years）. And 20 pa- tients with isolated ventricular septal defect （ VSD ） were included as VSD group during the same time, with 12 males and 8 females, whose median age of operation was 5 months （ rang from 1 month to 12.0 years）. Resting blood pressure, flow-media- ted dilation （ FMD ） of the brachial artery, carotid intima-media thickness （ IMT ） were compared in CoA group and VSD group, including preoperative media data and follow-up of 1 month, 6 months and 1 year. In addition, as comparison to the operation group, 20 health children with normal echoeardiographic findings, whose median age was 5 months （ rang from 3 month to 10.0 years）, were selected as health group for the 1 -year following up. None of them had obesity, hyperlipidemia, diabetes mellitus, metabolic diseases or systemic inflammatory disease. Results As a result of the datas before operation and those 1 month, 6 months and 1 year after operation, all children were normotensive at rest. In the same period, Carotid IMT in CoA group[ （0.47±0. 10） mm, （0.49±0. 10） mm, （0.57±0. 07）mm, （0. 61 ±0.07） mml was significantly thicker than that in VSD group [（0.41 ±0. 11 group [ （0

关 键 词：主动脉缩窄 动脉内中膜厚度 血流介导的血管舒张功能 

分 类 号：R726.5[医药卫生—儿科]