保留附加肺血流之双向腔肺分流术的利弊：计算机模拟分析  

Advantages and disadvantages of bidirectional cavopulmonary shunt with additional pulmonary blood flow： a theoretical analysis

作　　者：黄继红 苏肇伉[1] 刘锦纷[1] 孙琦[1] 史珍英[1] 周燕萍 

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胸外科,200127

出　　处：《中华胸心血管外科杂志》2012年第8期476-481,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金（30672087）

摘　　要：目的通过数学模型，分析附加肺血流（additional pulmonary blood flow，APBF）的意义及其流量控制。方法建立APBF—BCPS模型，计算机分析APBF对氧供（oxygen delivery，DO2）的影响，APBF流量对中心静脉压（central venous pressure，CVP）以及动脉氧饱和度（SaO2）的影响。结果APBF对机体的作用取决于上腔静脉血流量与下腔静脉血流量之比（QSVC／QIVC），QSVC／QIVC〉0．3时，保留APBF降低组织氧供；QSVC／QIVC〈0．3时，适当APBF有助于提高组织氧供。APBF流量增加和CVP增加呈线型相关，斜率与肺血管阻力正相关，用CVP的增加来衡量APBF流量是一种可行的方法。氧饱和度的增加与APBF流量及CVP的增加不是线型关系，用SaO2判断APBF流量可能引起误导。随年龄增加，QSVC／QIVC逐渐降低，BCPS加上适当的APBF有助于提高氧供。随年龄增加，无APBF的BCPS的患儿，QSVC／QIVC逐渐降低，氧供呈下降趋势；合并肺动静脉瘘则氧供急降。结论适龄且肺血管发育尚可患儿（QSVC／QIVC〉0．3），消除APBF能在心排血量相等情况下改善氧供。肺血管发育差（QSVC／QIVC 〈0．3）或年龄偏大患儿，需要适当APBF提高氧供。单纯BCPS循环远期氧供呈逐渐恶化趋势，对于选择BCPS作为最终术式的病例，建议保留APBF。Objective The bidirectional cavopulmonary shunt （BCPS） is a major step in the staged palliation of func- tionally univentricular heart defects. Whether to preserve of additional pulmona~＇y blood flow （APBF） has been a highly contro- versial issue. The purpose is to mathemalical model and set out to determine the significa advantages and disadvantages of bidi- rectional cavopulmonary shunt with additional pulmonary blood flow： a theoretical analysis nce of APBF and the appropriate APBF ratio. Methods We used models of the univentricular circulation after the bidirectional cavopulmonary anastomosis with additional pulmonary blood and to computational analyze the impact of APBF on oxygen delivery, APBF flow on the CVP and SaO2. Results The influence of APBF depends on the ratio of superior vena cava flow to inferior vena cava flow （ Qsvc/ Q^vc）- For Qsvc/Q^vc 〉 0. 3, APBF may be associated with decreased oxygen delivery. For Qsvc/Qtvc 〈 O, 3, appropriate APBF may be associated with increased oxygen delivery. A linear relationship exists between the increase of APBF and CVP, and the slope was depended on the value of pulmonary vascular resistance. Estimating APBF from CVP measurements may be a feasible method. A nonlinear relationship between the increase of APBF and oxygen saturation, and estimating APBF from SaO2 measurements may result in elTors. BCPS and appropriate APBF may optimal the oxygen delivery with the increase of age and the decrease in Qsvc/Qtvc. For patients who accepted BCPS without APBF, there is a decreasing tendency of oxygen delivery with the increase of age and the decrease in Qsvc/Qlvc. For patients who suffered pulmonary arterivenous mallformation, there is a more obvious decrease in oxygen delivery. Conclusion For patients under age who has normal pulmonary vascular bed（that is,QSVC/QIVC〉0.3）,elimination of additional pulmonary blood flow can improve the oxygen delivery under a given cardiac output.For patients who with hypoplastic pulmonary vascular or in older pat

关 键 词：心脏缺损 先天性 心脏外科手术 附加肺血流 双向腔肺分流术 计算机 模拟 

分 类 号：R654.2[医药卫生—外科学]