急性肺血管扩张试验在先天性心脏病相关性肺动脉高压中的意义  

The significance of acute pulmonary vasodilator testing in pulmonary hypertension associated with congenital heart disease

作　　者：刘洋[1] 沈群山[1] 张刚成[1] 尚小珂[1] 王利军[1] 卢蓉[1] 余莹[1] 陈谦 

机构地区：[1]武汉亚洲心脏病医院先心病中心,湖北武汉430022 [2]湖北省卫生和计划生育委员会

出　　处：《中国介入心脏病学杂志》2015年第1期14-17,共4页Chinese Journal of Interventional Cardiology

基　　金：国家十二五科技支撑项目(2011BAI11B15);湖北省卫生厅科研项目(JX6B90)

摘　　要：目的探讨急性肺血管扩张试验(acute pulmonary vasodilator testing,AVT)在先天性心脏病相关性肺动脉高压(CHD-PAH)中的作用。方法对2008年3月至2014年4月在武汉亚洲心脏病医院行右心导管及AVT检查的479例患者的临床资料进行回顾性分析,其中男105例,女374例。所有患者均采用吸入伊洛前列素行AVT检查,分别观察AVT检查的阳性率。并采集CHD-PAH患者行AVT检查前后的平均肺动脉压力(mP AP)、全肺血管阻力(TPR)、肺小动脉楔压(PCWP)、心输出量(CO)、肺循环血量/体循环血量(Qp/Qs)、肺循环阻力/体循环阻力(Rp/Rs)的变化。结果 479例CHD-PAH患者行AVT检查阳性患者为0例。479例CHD-PAH患者行AVT检查后mP AP由(69.2±15.7)mmH g(1 mmH g=0.133 kP a)降至(58.6±10.8)mmH g,TPR由(21.6±13.2)wood降至(18.8±6.8)wood,Qp/Qs由(1.6±1.3)升至(1.8±1.2),Rp/Rs由(0.9±0.2)降至(0.7±0.2)(P<0.01),CO及PCWP差异无统计学意义。479例CHD-PAH患者中达到手术标准的仅有34例患者,其中33例患者实施外科手术,随访6个月预后良好。结论 CHD-PAH患者行AVT检查的意义并不在于选择钙拮抗剂进行治疗,而是在于评价CHD-PAH患者是否有外科手术的适应证。Objective To explore the role and significance of acute pulmonary vasodilator testing（ AVT） in pulmonary hypertension associated with congenital heart disease（ CHD-PAH）. Methods The clinical data of 479 patients who had received right cardiac catheterization and AVT in March 2008 to April2014 in our hospital were retrospectively analyzed. Among these patients,105 cases were male and 374 cases are female. All patients received AVT by inhalation of iloprost. We recorded the changes in mean pulmonary artery pressure（ mPAP）,total pulmonary resistance（ TPR）,pulmonary artery wedge pressure（ PCWP）,cardiac output（ CO）,pulmonary blood volume / blood circulation（ Qp/ Qs）,pulmonary to systemic resistance（ Rp/ Rs） before and after AVT. Results The positive AVT rate in the whole study group was zero. After the AVT,there were decreases in mPAP from（ 69. 2 ± 15. 7） mmHg to（ 58. 6 ± 10. 8）mmH g,in TPR from（ 21. 6 ± 13. 2） wood to（ 18. 8 ± 6. 8） wood,and increases in Qp/ Qsfrom（ 1. 6 ± 1. 3）to（ 1. 8 ± 1. 2）,and Rp/ Rsfrom（ 0. 9 ± 0. 2） to（ 0. 7 ± 0. 2）（ all P〈0. 01）. There was no change in CO and PCWP. There were only 34 patients reached the standard criteria of surgery among the 479 patients of CHD-PAH patients and 33 of them received surgery with a satifactory findings after six months follow-up.Conclusions The significance of AVT examination in CHD-PAH patients lies in its role in guiding whether the CHD-PAH patients has surgical indications instead of verifying for calcium channel blockers treatment.

关 键 词：先天性心脏病 高血压 肺性 急性肺血管扩张试验 

分 类 号：R541.4[医药卫生—心血管疾病]