肺活检对先心病肺动脉高压手术的指征及预后估价

Lung Biopsy in Assessing the Indication for Operation and Prognosis in Patients with Congenital Heart Disease and Pulmonary Hypertension

对４１例分流性先天性心脏病合并肺动脉高压病人行肺活检。根据Ｈｅａｔｈ－Ｅｄｗａｒｄｓ六级分级标准进行肺小动脉的病理分级，并与血流动力学指标进行相关分析。结果表明，肺血管病理变化程度和ＰＡＰ／ＳＡＰ及ＰＶＲ呈正相关关系。ＰＡＰ／ＳＡＰ＞０．８，ＰＶＲ＞４５ｋＰａ·ｓ／Ｌ的病人术前应行肺活检，以对肺血管病变程度进行病理分级；Ⅰ～Ⅲ级属可逆性病变，手术效果好；病变Ⅳ～Ⅵ级属不可逆性病变，应视为手术禁忌证。

Forty-one patients with congenital heart disease and 2 pulmonary hypertension underwent lung biopsy in order to assess indication for operation and prognosis. The pulmonary vascular changes were graded according to the standard of Heath-Edwards Classification, and were correlated with the hemodynamic data. The authors suggest that preoperative open lung biopsy should be performed in patients with PAP/SAP>0.8 and PVR>450 dyn.sec.cm-5.pathological pulmonary vascular changes from Grade Ⅰ-Ⅲ are reversible Corrective surgery usually gives good result.However, in patients with HeathEdwards changes of grade Ⅳ￣Ⅵ, simple intracardiac correction is contraindicated because the vascular disease will progress after surgery.