负荷多普勒超声评价法乐氏四联症根治术后肺动脉反流的血液动力学反应

HEMODYNAMIC RESPONSE IN PATIENTS WITH PULMONARY REGURGITATION (PR) FOLLOWING TOTAL CORRECTIVE SURGERY OF TETRALOGY OF FALLOT:A STRESS DOPPLER ECHOCARDIOGRAPHIC ASSESSMENT

本文通过应用负荷多普勒超声无创方法评价法乐氏法乐氏四联症术后患者的运动耐量和肺动脉反流(PR)对血液动力学反应的影响。31例与按年龄、性别和体表面积的大小相匹配的20例正常志愿者作对照研究。在次极量仰卧运动中测量最大心率、心率血压双乘积、最大运动耐量指数。用多普勒超声测量静息和次极量仰卧运动时主动脉血流平均加速度、心脏指数、左室短轴缩短率及其它静息时的超声指标。结果显示:术后患者右室增大,与PR程度呈正相关,最大心率反应、氧消耗量和最大运动耐量指数较正常对照组均有降低(P<0.001)。按PR程度,将本组病例分成无、轻度、中度和重度PR组,无PR和轻度PR组的血液动力学反应接近正常,重度PR组有显著低心输出量反应,无PR组的最大运动耐量指数也低于正常对照组。法乐氏四联症术后患者运动耐量降低和血液动力学反应异常与PR相关,PR的产生与右室流出道重建方式有关。

The exercise endurance and hemodynamic response of PR to exercise in postoperative patients with TOF were evaluated noninvasively using stress Doppler echocardiography. Thirty one patients were studied with twenty normal volunteers matched it, age, sex and size (body surface area) as control. Maximal heart rate (MHR), double product of maximal heart rate and systolic blood pressure, and maximal endurance index (MEI) were measured during submaximal supine bicycle exercise. The average aortic acceleration, cardiac output index (CI), left ventricular percentage fractional shortening (FS) at rest and during submaximal exercise and other resting echocardiographic indexes were measured by two-dimensional Doppler echocardiography. The results showed that in the patients, the enlargement of right ventricle was positively related to the severity of PR (r=0.80, p=0.001); and maximal heart rate (p<0.01), maximal oxygen consumption (p<0.05) and MEI (p<0.001) were lower than those of normal during submaximal exercise. The patients were grouped as no, mild, moderate and severe PR according to the severity of PR by Doppler technique. Patients with no and mild PR had almost normal response to exercise but the former had MEI lower than normal. However, those with severe PR had marked low cardiac output response. It is concluded that in postoperative patients with TOF, the exercise endurance is lower than that of normal. The abnormal hemodynamic response to exercise in the patients is positively related to the severity of PR. Furthermore, the occurrence of PR bears on the mode of reconstruction of the right ventricular outflow tract.