介入治疗对法洛四联症姑息术后患者肺血管发育及心室功能的影响  

The effect of interventional therapy on pulmonary vascular development and ventricular function in patients with tetralogy of Fallot after palliative operation

作　　者：王志远[1] 金梅[1] 丁文虹[1] 王霄芳[1] 郭保静[1] 梁永梅[1] 吕震宇[1] WANG Zhiyuan;JIN Mei;DING Wenhong;WANG Xiaofang;GUO Baojing;LIANG Yongmei;LV Zhenyu(Department of Pediatric Cardiac Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,100029

出　　处：《心肺血管病杂志》2020年第8期919-923,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨介入治疗对法洛四联症(TOF)姑息术后患者肺血管发育及心室功能的影响。方法:选择2016年6月至2018年6月,收治的TOF姑息术后1年肺动脉发育仍未达到根治术条件患者43例为研究对象,所有患者均行经皮肺动脉瓣球囊扩张术,随访3个月、12个月,观察患者心肺压力参数、肺血管发育情况、心肌损伤标志物及并发症等指标。结果:术后3个月、12个月,TOF姑息术后患者肺动脉瓣压力阶差(PTG)明显低于手术前,血氧饱和度(SaO2)明显高于手术前(P<0.05,P<0.01),McGoon比值、Nakata指数、肺动脉瓣环径、左肺动脉直径、右肺动脉直径明显高于手术前(P<0.05,P<0.01),血清CK-MB、LHD、肌红蛋白(MB)、BNP明显低于手术前(P<0.01);术后12个月,TOF姑息术后患者PTG明显低于术后3个月,SaO2明显高于术后3个月(P<0.05),McGoon比值、Nakata指数、肺动脉瓣环径、左肺动脉直径、右肺动脉直径明显高于术后3个月(P<0.05,P<0.01),CK-MB、LHD、MB、BNP明显低于术后3个月(P<0.05);43例TOF姑息术后患者中,术中出现心律不齐1例、血压下降1例,术后发热1例,并发症发生率7.0%(3/43)。结论:介入治疗能够有效调节TOF姑息术后患者血流动力学,促进肺血管发育,改善心室功能,且安全性值得肯定。Objective:To explore the effect of interventional therapy on pulmonary vascular development and ventricular function in patients with tetralogy of Fallot(TOF)after palliative operation.Methods:From June 2016 to June 2018,43 patients with TOF with pulmonary artery development not reaching the conditions of radical operation in one year after palliative operation were selected as the study objects.All patients were followed up for 3 and 12 months to observe the indexes of cardiopulmonary pressure parameter,pulmonary vascular development,Myocardial injury marker and complications.Results:At 3 and 12 months after operation,PTG,SaO2,McGoon ratio,Nakata index,diameter of pulmonary valve,were significantly lower than those before operation(P<0.05,P<0.01).It was significantly higher than that before operation(P<0.05,P<0.01),serum CK-MB,LHD,myoglobin(MB),BNP was significantly lower than that before operation(P<0.01);12 months after operation,PTG,SaO2 were significantly higher than that after operation(P<0.05),McGoon ratio,Nakata Index,pulmonary valve diameter and,left pulmonary artery,right pulmonary artery were significantly higher than those of 3 months postoperatively(P<0.05,P<0.01),CK-MB,LHD,MB and BNP were significantly lower than those of 3 months postoperatively(P<0.05);among 43 patients with TOF,arrhythmia occurred in 1 case,blood pressure decreased in 1 case,postoperative fever in 1 case,and complication rate was 7.0%(3/43).Conclusions:Interventional therapy can effectively regulate the hemodynamics,promote the development of pulmonary blood vessels and improve the ventricular function in patients with complex congenital palliative surgery,and it is safe.

关 键 词：法洛四联症 姑息术 经皮肺动脉瓣球囊扩张术 肺动脉发育 心室功能 

分 类 号：R54[医药卫生—心血管疾病]