不同高原海拔地区动脉导管未闭儿童肺动脉压力特点  

Evaluation of the characteristics of pulmonary artery pressure in children with patent ductus arteriosus at different altitudes

作　　者：张兴 苏忠剑 刘洪玉[1] 肖颖[1] 郑楠 闵杰青[1] 张瑜华 李斌[1] ZHANG Xing;SU Zhongjian;LIU Hongyu;Xiao Yin;ZHENG Nan;MIN Jieqing;ZHANG Yuhua;LI Bin(Department of Cardiovasology,Kunming Children's Hospital,Kunming 650034,Yunnan,China)

机构地区：[1]昆明市儿童医院心血管病内科,云南昆明650034

出　　处：《临床儿科杂志》2021年第1期22-25,共4页Journal of Clinical Pediatrics

基　　金：昆明市科技计划项目(No.2016-2-S-06869);昆明市卫生人才培养项目[No.2017-SW(后备)-105];昆明市卫生人才培养项目[No.2017-SW(后备)-109]。

摘　　要：目的探讨高原大气环境对儿童动脉导管未闭(PDA)发生、肺动脉压力(PAP)的影响。方法回顾分析2016年至2019年接受介入心导管检查及PAP测定的云南省不同海拔地区儿童的临床资料。运用COOK 5F心脏介入指引导管及LLC PX260压力传感器测量单纯PDA儿童的肺动脉收缩压(PASP)、舒张压(PADP)及平均压(mPAP);居住地海拔通过卫星地图等高线查询。结果纳入266例单纯PDA儿童,居住地海拔在<1500 m、≥1500 m儿童的mPAP分别为(24.0±5.8)和(25.1±8.4)mmHg,接近或高于儿童肺动脉高压诊断界值(25 mmHg)。随着PDA管径增粗、居住地海拔升高,儿童的mPAP水平表现出随之升高趋势。方差分析显示,不同居住海拔、不同管径PDA儿童之间,PASP、PADP及mPAP差异均有统计学意义(P<0.05)。多元线性回归分析显示,儿童PDA管径与mPAP呈正相关关系(P<0.001)。结论暴露于低气压、低氧大气环境可能是导致高原地区PDA儿童发生及儿童期PAP保持在较高水平的重要因素之一。云南省PDA>2 mm儿童mPAP水平高于25 mmHg,且随着居住地海拔升高与管径增粗,PDA导致的肺动脉高压越显著,可能从封堵治疗中获得更多的健康收益。Objective To explore the influence of plateau atmospheric environment on the incidence of patent ductus arteriosus(PDA)and pulmonary artery pressure(PAP)in children.Methods The clinical data of children at different elevations in Yunnan province who received interventional cardiac catheterization and PAP determination from 2016 to 2019 were analyzed retrospectively.Pulmonary artery systolic pressure(PASP),pulmonary artery diastolic pressure(PADP)and mean PAP(mPAP)were measured by the COOK 5F interventional guide catheter and LLC PX 260 pressure sensor in children with PDA alone.The altitude of residence was queried through satellite maps.Results Among the 266 children with PDA alone,the mPAP of the children living at altitudes less than 1500 m and more than 1500 m were(24.0±5.8)and(25.1±8.4)mmHg respectively,which were close to or higher than the diagnostic threshold of pulmonary hypertension(25 mmHg)in children.The mPAP level of children showed an increasing trend with the increase of PDA diameter and the altitude of residence.The analysis of variance showed that there were significant differences in PASP,PADP,and mPAP among PDA children living at different altitudes and with different PDA diameters(P<0.05).Multiple linear regression analysis showed that there was a positive correlation between PDA diameter and mPAP(P<0.001).Conclusions Exposure to atmosphere of low pressure and low oxygen may be one of the important factors that lead to the incidence of PDA and the persistence of high PAP in children in plateau areas.As the altitude at residence was elevated and the diameter was increased,PDA-induced pulmonary hypertension becomes more prominent.These children may gain more health benefits from occlusion treatment.

关 键 词：动脉导管未闭 肺动脉压 心导管检查 儿童 

分 类 号：R725.4[医药卫生—儿科]