无创性评估肺血减少先天性心脏病肺血管的发育

Noninvasive evaluation of pulmonary vascular development in congenital heart disease with decreased pulmonary blood flow

目的探求一种无创性评估肺血管发育情况的方法。方法采用112例肺血减少患者的数字减影心血管造影及超声心动图像,分别多点测量肺动脉近端、远端,将造影与超声所测结果进行相关分析;并将超声所测左、右肺动脉远端截面积之和/体表面积(EPAI)与术后情况进行相关分析。结果心血管造影与超声心动图测量结果高度相关,肺动脉总干r=0.79,左肺动脉近端r=0.73,右肺动脉近端r=0.77,左肺动脉远端r=0.69,右肺动脉远端r=0.89。EPAI与术后监护时间,呼吸机维持时间,正性肌力药物用量相关。EPAI≤115mm2/m2时,血流动力学很不稳定,低心排发生率与死亡率明显增加。结论EPAI是无创性评估肺血管发育及肺血流情况的良好指标,能为外科手术方案的选择提供有效依据。

Objective To seek a new method for noninvasive estimation of pulmonary artery. Methods Pulmonary artery diameters were measured at proximal, middle, distal portions on DSA and tapes of echocardiography in 112 patients with congenital heart disease with decreased pulmonary blood flow. The correlation was analyzed between the results of echocardiography and angiocardiography. The correlative analysis was done between echocardiography pulmonary artery index （EPAIs） and postoperative outcome. Results Excellent correlations between echocardiography and angiocardiography were obtained （the main pulmonary artery： r=0.79, proximal portion of the left pulmonary artery： r= 0. 73, proximal portion of the right pulmonary artery： r=0.77, distal portion of the left pulmonary artery： r=0.69, distal portion of the right pulmonary artery： r=0. 89）. The length of day in ICU, mechanical ventilation time, dose of inotropic drugs correlated well with EPAI, when EPAI≤115 mm^2/m^2 , postoperative hemodynamics was unstable, the frequency of low cardiac output syndrome and mortality significantly increased. Conclusion EPAI is an excellent morphological indicator of pulmonary blood flow and development status of pulmonary vessels. It may improve the decision-making strategy.