法乐氏四联症根治术后运动功能和运动风险的研究  

Exercise capacity and exercise risk after surgical repair of tetralogy of Fallot

作　　者：郭颖[1] 周爱卿[1] 李奋[1] 高伟[1] 李筠[1] 杨健萍[1] 朱敏[1] 张海燕[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心内科,200127

出　　处：《中华心血管病杂志》2003年第9期673-677,共5页Chinese Journal of Cardiology

摘　　要：目的　研究法乐氏四联症 (TOF)根治术后运动功能和运动风险 ,并探讨相关因素对远期预后的影响。方法　 5 4例TOF根治术后患儿依次进行心电图、2 4小时动态心电图、超声心动图和运动试验。结果　除 13～ 14岁年龄组外 ,其余各组TOF根治术后患儿静息心率和收缩压与正常同龄儿童差异无显著性 ,但其极量心率和最大收缩压均明显低于正常对照组。TOF术后患儿运动耐量平均为正常同龄标准的 ( 81 7± 13 8) %。运动耐量与肺动脉瓣返流程度、体外循环时间、手术年龄、右室流出道梗阻程度呈负相关。 18例存在室性心律失常的患儿平均运动耐量为 ( 6 9 4± 2 0 1) % ,35例无室性心律失常的患儿平均运动耐量为 ( 85 5± 7 8) % ,两者差异有显著性 (t=3 2 2 8,P <0 0 1)。2例患儿运动诱发频发多源室性早搏。结论　TOF术后运动功能较正常同龄降低约 2 0 % ,影响运动功能的主要因素包括右室收缩压增高、中 重度肺动脉瓣返流、手术年龄、体外循环时间和心律失常。运动诱发频发多源室早提示存在严重的血流动力学异常 ,发生室性心动过速的风险增高。早期进行手术 。Objective To assess exercise capacity and exercise risk after surgical repair of tetralogy of Fallot Methods Electrocardiogram, echocardiogram, exercise testing on treadmill and 24 hours electrocardiogram were performed in 54 patients,4 3±1 7 years (range 2 8 to 9 0 years)after intracardiac repair of tetralogy of Fallot Results Blood pressure and heart rate measured at rest were similar between normal control and TOF group except the 13 to 14 years age group A normal increase in systolic blood pressure and heart rate was observed in response to exercise intensity for all children However, maximal working capacity is (81 7±13 8)% in TOF group when compared with control children Work capacity was inversely related to residual disease, notably moderate to severe pulmonary regurgitation, age at operation, duration of cardiopulmonary bypass and ventricular arrhythmia Exercise induced frequent polymorphic multiform ventricular premature beats were recorded in 2 patients Conclusion Maximal working capacity is generally reduced by 20% in TOF group when compared with healthy children Factors influenced exercise capacity include the degree of obstruction of the right ventricular outflow tract, pulmonary valve regurgitation, age at operation, duration of extracorporeal circulation and ventricular arrhythmia Exercise induced polymorphic ventricular premature beats are highly associated with abnormal hemodynamic status and prone to ventricular tachycardia Patients operated at early infant period with normal or near normal hemodynamic will ensue with better prognosis

关 键 词：法乐氏四联症 根治术 术后 运动功能 运动风险 预后 

分 类 号：R726.5[医药卫生—儿科]