MSCT对动脉导管依赖型肺动脉闭锁合并室间隔缺损患者的肺血管发育情况的评估及其与血氧饱和度的关系  

MSCT evaluation of pulmonary vascular development in patients with ductal-dependent pulmonary atre⁃sia complicated with ventricular septal defect and its correlation with blood oxygen saturation

作　　者：罗纯 席悦 张丽丽[1] 蒋骏[3] LUO Chun;XI Yue;ZHANG Li-li;JIANG Jun(Department of Radiology,The First People′s Hospital of Foshan,Foshan,Guangdong 528000,China;Department of Radiology,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Medical Imaging,The Second People′s Hospital of Shenzhen,The First Affiliated Hospital of Shenzhen University,Shenzhen,Guangdong 518000,China)

机构地区：[1]佛山市第一人民医院影像科,广东佛山528000 [2]广东省人民医院(广东省医学科学院)放射科,广州510080 [3]深圳市第二人民医院(深圳大学第一附属医院)医学影像科,广东深圳518000

出　　处：《岭南心血管病杂志》2021年第6期667-672,共6页South China Journal of Cardiovascular Diseases

基　　金：佛山市高校和医院科研基础平台建设(项目编号:2015AG10004)。

摘　　要：目的分析多层螺旋计算机断层扫描(multi-slice computed tomography,MSCT)对动脉导管依赖型肺动脉闭锁合并室间隔缺损(pulmonary atresia complicated with ventricular septal defect,PA/VSD)患者肺血管发育情况的评估,及其与患者术前血氧饱和度的关系。方法回顾性收集99例动脉导管依赖型PA/VSD患儿的临床及MSCT检查资料,分析MSCT对肺血管评估的相关指标与手术分型及患者术前血氧饱和度的关系。结果根治手术与姑息手术患者的McGoon比值(McGoon ratio,M率)、肺动脉指数(pulmonary arterial index,PAI;Nakata)、总的新肺动脉指数(total neopulmonary arterial index,TNPAI)及肺静脉指数(pulmonary vein index,PVI)比较,差异均有统计学意义(P<0.001,P<0.001,P<0.001,P=0.001);M率、PAI、TNPAI及PVI与患者术前血氧饱和度有弱相关关系(P=0.009,r=0.261;P=0.036,r=0.210;P=0.006,r=0.272;P=0.004,r=0.286),且相关系数PVI>TNPAI>M率>PAI。结论术前MSCT能够评估动脉导管依赖型PA/VSD患儿的肺血管发育情况,目前临床根治及姑息手术的选择也主要依赖于术前MSCT对肺血管发育的评估,且肺血管发育评估的指标与术前血氧饱和度存在一定的相关性,虽然差异不大,但是相关系数呈现的趋势可能说明肺静脉的评估可能较肺动脉更有意义。Objectives To evaluate the pulmonary vascular development in patients with ductal-dependent pulmonary atresia complicated with ventricular septal defect(PA/VSD)by multi-slice computed tomography(MSCT),and to observe the correlation between pulmonary vascular development and preoperative blood oxygen saturation.Methods The clinical and MSCT examination data of 99 children with ductal-dependent PA/VSD,the development of the children′s pulmonary blood vessels,and the relationship between the development of the pulmonary blood vessels and preoperative blood oxygen saturation were retrospectively analyzed.Results The McGoon ratio(M rate),pulmonary arterial index(PAI/Nakata),total neopulmonary arterial index(TNPAI)and pulmonary vein index(PVI)between patients underwent radical surgery and palliative surgery were statistically significant(P<0.001,P<0.001,P<0.001,P=0.001).M rate,PAI,TNPAI and PVI had significant positive weak correlations with preoperative blood oxygen saturation(SaO2)(P=0.009,r=0.261;P=0.036,r=0.210;P=0.006,r=0.272;P=0.004,r=0.286),and the correlation coefficient were PVI>TNPAI>M rate>PAI.Conclusions Preoperative MSCT can very accurately assess the pulmonary vascular development of children with ductal-dependent PA/VSD.At present,the choice of clinical radical and staged surgery also mainly depends on the assessment of pulmonary vascular development on the preoperative MSCT.There is a certain correlation between the evaluation index and preoperative SaO_(2).Although the difference is not obvious,the trend of the correlation coefficient may indicate that the evaluation of the pulmonary vein may be more meaningful than the pulmonary artery.

关 键 词：肺动脉闭锁合并室间隔缺损 动脉导管未闭 肺血管发育 血氧饱和度 

分 类 号：R541.1[医药卫生—心血管疾病]