经皮房间隔缺损封堵术后肺动脉高压的变化及其影响因素  

Changes and influencing factors of pulmonary hypertension after percutaneous atrial septal defect closure

作　　者：姬广招 李风祥 JI Guangzhao;LI Fengxiang(the Seventh People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院,河南郑州450000

出　　处：《临床医学研究与实践》2025年第9期42-45,共4页Clinical Research and Practice

摘　　要：目的探讨房间隔缺损(ASD)封堵手术前、后肺动脉高压(PH)的患病率变化及ASD封堵术后患者临床特征与PH变化的关系。方法回顾性分析2016年1月至2021年12月在我院接受经皮ASD封堵术的128例继发孔型ASD患者的资料,依据超声心动图测量平均肺动脉压的不同将患者分为3组[无PH组(<25 mmHg)、可能PH组(25~35 mmHg)、PH组(>35 mmHg)]。分析术后1年左右PH的变化情况,并使用Logistic回归分析探讨ASD患者术后发生PH的影响因素。结果ASD封堵术前,三组的年龄、NYHA分级为Ⅲ~Ⅳ级占比、心脏用药占比、右心房面积及右心室直径比较,差异具有统计学意义(P<0.05)。中位随访时间为13.3个月;ASD封堵术前78例(60.9%)患者无PH,而ASD封堵术后114例(89.1%)患者没有出现PH;ASD封堵术前33例(25.8%)患者可能患有PH,而ASD封堵术后9例(7.0%)患者可能有PH;ASD封堵术前PH的患病率为13.3%(17/128),而ASD封堵术后PH的患病率为3.9%(5/128)。多因素Logistic回归分析结果显示,NYHA分级较高、心脏用药是影响ASD患者术后PH的因素(P<0.05)。结论在ASD封堵术后大约有3.9%的患者仍然存在PH,特别是ASD封堵前肺动脉压高、NYHA分级高、心脏用药患者的风险较高。Objective To investigate the changes of prevalence rate of pulmonary hypertension(PH)before and after percutaneous atrial septal defect(ASD)closure and the correlation between clinical characteristics and PH changes after ASD closure.Methods The datas of 128 patients with secundum ASD who underwent percutaneous ASD closure in our hospital from January 2016 to December 2021 were retrospectively analyzed.The patients were divided into three groups[non-PH group(<25 mmHg),possible PH group(25-35 mmHg),pH group(>35 mmHg)]according to the difference of mean pulmonary artery pressure measured by echocardiography.The changes of PH around 1 year after operation were anzlyzed,and Logistic regression analysis was used to explore the factors affecting postoperative PH in patients with ASD.Results Before ASD closure,there were statistically significant differences in age,proportion of NYHA gradeⅢ-Ⅳ,proportion of cardiac medication,right atrial area and right ventricular diameter among the three groups(P<0.05).The median follow-up period was 13.3 months;78 patients(60.9%)had no PH before ASD closure,while 114 patients(89.1%)had no PH after ASD closure;before ASD closure,33 patients(25.8%)may have PH,while 9 patients(7.0%)may have PH after ASD closure;the prevalence rate of PH before ASD closure was 13.3%(17/128),while the prevalence rate of PH after ASD closure was 3.9%(5/128).Multivariate Logistic regression analysis results showed that higher NYHA classification and cardiac medication were the factors affecting postoperative PH in patients with ASD(P<0.05).Conclusion About 3.9%of patients still have PH after ASD closure.Especially patients with high pulmonary artery pressure before ASD closure,high NYHA classification and cardiac medication have higher risk.

关 键 词：房间隔缺损 肺动脉高压 经皮房间隔缺损封堵术 心脏彩超 

分 类 号：R541.1[医药卫生—心血管疾病]