46例经皮球囊肺动脉瓣成形术后患儿运动功能的研究

Exercise capacity evaluation after percutaneous balloon pulmonary valvuloplasty in children with pulmonary valve stenosis

目的经皮球囊肺动脉瓣成形术(pereutaneous balloon pulmonary valvuloplasty,PBPV)已成为治疗肺动脉瓣狭窄的首选方法,本研究旨在应用平板运动试验观察 PBPV 后患儿运动耐量和运动心率、血压反应以及心电图变化,探讨相关因素对远期预后的影响。方法46例经皮球囊肺动脉瓣成形术后患儿采用 Bruce 方案进行平板运动试验,观察其运动耐量和运动心率、血压反应以及心电图变化。同期对294例健康儿童进行平板运动试验,测定各年龄组运动耐量均值,并从中随机选取46例年龄、性别相仿的儿童作为正常对照组。结果 PBPV 后患儿跨肺动脉瓣压差稳定在25 mm Hg(1 mm Hg=0.133 kPa)以下,平均运动耐量可达正常同龄标准的90%左右,且运动所能达到的负荷量与 PBPV 前跨瓣压差无明显相关性。运动心率、血压反应正常。运动功能与术时年龄、PBPV 所选用的球囊/瓣膜比值有关。5例患儿运动试验诱发室性心律失常,均为偶发室性早搏,运动试验过程中无一例出现 ST 段异常变化。结论早期解除右室流出道梗阻有利于远期运动功能的改善。PBPV时采用适度的球囊/瓣膜比值(1.2～1.4)值得推荐。但对于术后发生的肺动脉瓣反流仍应长期随访观察。

Objective To assess exercise capacity after percutaneous balloon pulmonary valvuloplasty （PBPV） in children with isolated pulmonary valve stenosis. Methods Treadmill exercise testing was performed in 46 children （6.3 ±3.1 years, ranging 1 to 12. 5 years） with isolated pulmonary valve stenosis post PBPV and in 294 healthy children. Exercise capacity, change in heart rate, blood pressure, and electrocardiogram during exercise were observed. Results Post PBPV, the transvalvar gradient was below 25 mm Hg（1 mm Hg =0. 133 kPa） in all patients. The mean work capacity in pest PBPV children was about 90 percent of that in healthy children. Heart rate and blood pressure response to exercise is comparable to healthy children. Factors associated with exercise capacity include age at operation and the ratio of balloon/pulmonary valve diameter. Exercise-induced uniform ventricular premature contraction in 5 children post PBPV and no ST segment change was observed. Conclusion Exercise capacity post percutaneous balloon pulmonary valvuloplasty in children with isolated pulmonary valve stenosis was comparable to that in healthy children.