上腔静脉-肺动脉双向分流术后患者60例的心导管检查及临床综合评价  

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

作　　者：汤尚秋 李一凡[1] 张智伟[1] TANG Shang-qiu;LI Yi-fan;ZHANG Zhi-wei(Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of MedicalSciences,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2019年第1期87-91,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的通过分析行上腔静脉-肺动脉双向分流术(双向Glenn术)后患者的心导管检查结果,评价双向Glenn术的手术效果及指导复杂先天性心脏病(congenital heart disease,CHD)患者的下一步治疗。方法选择2014年1月至2016年12月60例双向Glenn术后在广东省人民医院接受心导管检查的患者,记录其住院期间的Glenn及全腔静脉-肺动脉连接术(total cavopulmonary connection,TCPC)术前、术后经皮血氧饱和度(percutaneous oxygen saturation,SpO_2)、6 min步行试验(6-minute walk test,6MWT)、心导管检查资料[测量上腔静脉平均血压(mean superior vena cava pressure,m SVCP)、上腔静脉收缩期血压(superior vena cava systolic bloodpressure,sSVCP)、右肺动脉收缩压(right pulmonary artery systolic pressure,sRPAP)、右肺动脉平均压(meanright pulmonary artery pressure,mRPAP)、左肺动脉收缩压(left pulmonary artery systolic pressure,sLPAP)、左肺动脉平均压(mean left pulmonary artery pressure,m LPAP)、肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP),并计算出相应的肺血管阻力(pulmonary vascular resistance,PVR)、肺小血管阻力(small pulmonaryvascular resistance,sPVR)]及术后并发症,通过受试者工作特征曲线(receiver operator characteristicu crve,ROC)寻找进行TCPC的最佳截断点。结果 60例Glenn术后患者的SpO_2较术前明显上升,差异有统计学意义(75.42%±9.62%vs. 86.98%±7.63%,P<0.001)。47例TCPC术后患者的SpO_2较术前明显升高,差异有统计学意义(82.70%±5.99%vs. 95.00%±4.07%,P<0.05)。42例Glenn术后患者完善6MWT,其步行距离为(362.7±75.0)m,步行6 min后SpO_2较步行前明显下降,差异有统计学意义(81.80%±7.84%vs. 67.59%±1.82%,P<0.05)。47例患者能进行下一步TCPC手术。进行TCPC组的sRPAP、mRPAP、mLPAP、PVR、sPVR均明显低于不进行TCPC组,差异有统计学意义(P<0.05)。两组间sSVCP、mSVCP、sLPAP比较,差异无统计学意义(P>0.05)。sSVCP≤20 mmHg(P=0.025,1 mmHg=0.133 kPa)是TObjectives To evaluate the effectiveness of cavopulmonary bidirectional shunt(bidirectional Glenn shunt)in patients with complex congenital heart disease(CHD)by cardiac catheterization results,and to guide follow-on treatment for patients with CHD.Method Sixty patients,44 male and 16 female,with bidirectional Glenn shunt surgery and cardiac catheterization for CHD were enrolled at Guangdong Provincial People′s Hospital between January 2014 and December 2016.Pre-and post-Glenn shunt percutaneous oxygen saturation(SpO2),6-minute walk test(6MWT),mean superior vena cava pressure(mSVCP),superior vena cava systolic blood pressure(sSVCP),right pulmonary artery systolic pressure(sRPAP),mean right pulmonary artery pressure(mRPAP),left pulmonary artery systolic pressure(sLPAP),mean left pulmonary artery pressure(mLPAP),pulmonary capillary wedge pressure(PCWP),pulmonary vascular resistance(PVR)and small pulmonary vascular resistance(sPVR)were measured.Pre-and posttotal cavopulmonary connection(TCPC)SpO2 and in-hospital complications were monitored.The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic(ROC)curve analysis.Results SpO2 was significantly increased by bidirectional Glenn shunt surgery(75.42%±9.62%to 86.98%±7.63%,P<0.001)and from 82.70%±5.99%to 95.00%±4.07%in the 47 patients with TCPC(P<0.05).Forty-two patients completed the 6MWT with a mean distance of(362.7±75.0)m and a SpO2 decreased from 81.80%±7.84%to 67.59%±1.82%(P<0.001).After cardiac catheterization,47 patients were selected for TCPC.sRPAP,mRPAP,mLPAP,PVR and sPVR were significantly lower in TCPC group than in non-TCPC group(P<0.05).The differences in sSVCP,mSVCP and sLPAP were not significant.The optimal cutoff values for TCPC were sSVCP≤20 mmHg(P=0.025,1 mmHg=0.133 kPa).sRPAP≤22 mmHg(P=0.0001),mRPAP≤13 mmHg(P=0.003),sLPAP≤27 mmHg(P=0.03),mLPAP≤11 mmHg(P=0.01),PVR≤4.3 WoodU/m2(P<0.0001)were significantly associated with TCPC selection,but mSVCP≤19 mmHg(P=0.06)and sPVR≤2

关 键 词：先天性心脏病 上腔静脉-肺动脉双向分流术 6min步行试验 心导管检查 全腔静脉-肺动脉连接术 

分 类 号：R541.7[医药卫生—心血管疾病]