法洛四联症矫治术后中远期肺动脉高压  

The long-term pulmonary hypertension after the operation of tetralogy of Fallot

作　　者：卢蓉[1] 尚小珂[1] 张刚成[1] 沈群山[1] 肖书娜[1] 周红梅[1] 

机构地区：[1]武汉亚洲心脏病医院先心中心,湖北省武汉市430022

出　　处：《中国心血管病研究》2015年第9期847-850,共4页Chinese Journal of Cardiovascular Research

基　　金：基金项目：2014年武汉市中青年医疗骨干专项培养项目

摘　　要：目的 探讨法洛四联症（TOF）矫治术后中远期肺动脉压力及阻力升高机制.方法 2009年1月至2011年4月我院行法洛四联症矫治术共181例.随访2～5年,对怀疑患肺动脉高压者行右心导管检查,最终确诊19例.分析单纯TOF矫治术后产生肺动脉高压的因素.结果 19例患者在随访的2～5年内绝大多数未出现明显临床症状.WHO心功能评定Ⅰ/Ⅱ级17例、Ⅲ/Ⅳ级2例.问卷调查Bog呼吸困难评分为1～7分,中位数为4分.BNP检查为11～＞5000 pg/ml,BNP的中位数为266 pg/ml.右心导管检查示不同程度的肺动脉压力和阻力升高,其中轻度肺动脉高压16例,占绝大多数.肺小动脉楔入压均正常（6～10 mm Hg）,肺动脉-右心室连续测压压力阶差＜10 mm Hg,右房压力属正常范围（6～11 mm Hg）.部分患者同时行肺小动脉造影,没有发现肺动脉高压特征性改变,无急性肺血管扩张试验阳性者.结论 法洛四联症矫治术后患者中远期会出现肺动脉高压及全肺阻力升高.其机制目前并不十分确定清楚,可能是一个多因素交叉的复杂过程.Objective To investigate the change of pulmonary artery pressure during the long-term fol- low-up in patients with tetralogy of Fallot undergone operation. Methods Retrospective analysis 181 patients from Janu 2009 to Apri 2011 in our hospital who accepted tetralogy of Fallot correction surgery, there were 19 cases suspected of having pulmonary hypertension and final were confirmed by right heart catheterization after followed up for 2-5 years, so the influential factor of pulmonary hypertension produced after correction of TOF were analyzed. Results All of the 19 patients do not have any obviously clinical symptoms in the follow-up years, WHO cardiac functional grading was grade Ⅰ or Ⅱ in 17 cases, 2 cases were grade Ⅲ or Ⅳ. Borg dyspnea score was 1 to 7 points by questionnaire method, with a median value of 4 points. BNP was from 11 to 5000 pg/ml, median value was 266 pg/ml. Right heart catheterization showed there were vary degrees of increase in pulmonary artery pressure and resistance, in which most was mild increased （ 16 cases ）. The pulmonary artery wedge pressure of all patients were in normal range（6-10 mm Hg）. The difference from pulmonary artery to right ventricular continuous pressure t was less than 10 mm Hg. The right atrial pressure were in normal range （6-11 mm Hg）. Some pa- tients accepted pulmonary artcriography simuhaneously, but have not found characteristic changes of pulmonary hypertension. None acute pulmonary vasodilator testing was positive. Conclusion The pulmonary hypertension and total pulmonary resistance will increased in the long term of some patients after tetralogy of Fallot surgery, but its mechanism is not very clear, it may be a complex process of multi-factor and multi-cross.

关 键 词：法洛氏四联症 肺动脉高压 全肺阻力 肺血管 解剖学矫正 外科手术 

分 类 号：R654.2[医药卫生—外科学]