先天性心脏病继发重度肺动脉高压患者的肺活检研究  

Study on lung biopsy in patients with severe pulmonary hypertension secondary to congenital heart disease

作　　者：黄景彬[1] 梁健[1] 赵晓芳[1] 杜茗[2] 朱耀斌[2] 刘迎龙[2] 

机构地区：[1]广西中医药大学附属瑞康医院心胸外科,南宁530011 [2]北京协和医学院/中国医学科学院阜外心血管病医院心血管病研究所小儿心脏中心,北京100037

出　　处：《重庆医学》2014年第36期4854-4856,共3页Chongqing medicine

基　　金：国家自然基金资助项目(30972958);国家自然基金资助项目(81360014);广西科技关项目(2013B[26236]);广西自然基金资助

摘　　要：目的研究先天性心脏病继发重度肺动脉高压患者肺小动脉病变的性质。方法先天性心脏病继发重度肺动脉高压患者均通过诊断性治疗选择后行根治性手术(n=49)。在心脏手术中取肺组织活检,用Heath-Edwards(H-E)法分级,进行量化分析,计算肺小动脉中膜面积百分比,中膜厚度百分比和肺小动脉密度。结果诊断性治疗后患者经皮血氧饱和度明显提高(P<0.01),无手术死亡病例。术后平均肺动脉压和肺血管阻力明显下降(P<0.01)。38例(77.6%)为H-EⅠ级,5例(10.2%)H-EⅡ级,4例(8.2%)H-EⅢ级,2例(4%)H-EⅣ级伴丛样病变。随访结果表明H-EⅣ级伴丛样病变患者肺血管病仍可逆。结论通过诊断性治疗选择先天性心脏病继发重度肺动脉高压患者的肺血管病通常是可逆的,仍可行根治术。Objective To investigate the nature of the pulmonary arterioles in the patients with severe pulmonary hypertension secondary to congenital heart disease .Methods All patients with congenital heart disease and secondary severe pulmonary hyper‐tension（PH） were selected by using diagnostic‐treatment to undergo the radical repair（n= 49） .The lung biopsy specimens were ob‐tained during operation .The nature of pulmonary vascular disease （PVD） was determined by Heath‐Edwards classification system . All specimens were quantitatively analyzed by calculating the arteriole medial area percentage ,medial thickness percentage and arte‐riole density .Results The transcutaneous oxygen saturation in all selected patients was increased significantly after diagnostic‐treatment（P〈0 .01） .There was no case of operative death .The postoperative mean pulmonary artery pressure and pulmonary vas‐cular resistance were decreased significantly （P〈 0 .01） .38 cases （77 .6% ） showed the H‐E grade Ⅰ change ,5 cases （10 .2% ） showed the H‐E grade Ⅱ change ,4 cases（8 .2% ） showed the H‐E grade Ⅲ chfange and only 2 cases （4% ） showed the H‐E gradeⅣ change with plexiform lesion .Conclusion The pulmonary vessels in the selected patients with severe PH secondary to congenital heart disease by using the diagnostic‐treatment are generally reversible and still feasible for performing the radical operation .

关 键 词：肺动脉高压 先天性心脏病 肺血管病 可逆性 先进肺动脉高压治疗 

分 类 号：R541.1[医药卫生—心血管疾病]