中大型室间隔缺损肺动脉高压时滞特征及肺动脉顺应性的超声评价

Echocardiographic evaluation for pulmonary arterial compliance and time lag of pulmonary hypertension in patients with moderate-sized or large ventricular septal defect

目的:分析中大型室间隔缺损患者的肺动脉高压与年龄的相关关系,并探讨肺动脉顺应性指数(pulmonary arterial compliance index,PACI)评价严重阻塞性肺血管病变的潜在价值。方法:应用多普勒超声心动图对349例中大型室间隔缺损患者进行检查,分别测量室间隔缺损直径和跨缺损分流压差,公式计算室间隔缺损面积指数、肺动脉收缩压和肺动脉顺应性指数。结果:年龄与肺动脉收缩压的偏相关系数为0.11(P<0.001)。室间隔缺损面积指数与肺动脉收缩压的偏相关系数为0.49(P<0.001)。肺动脉顺应性指数与年龄的相关关系无统计学意义(r=0.04,P>0.05)。≥15岁组的肺动脉顺应性指数低于其他年龄组(χ2=8.432,P<0.05)。手术禁忌证组和术后恢复较差组的肺动脉顺应性指数均明显低于术后恢复较佳组,手术禁忌证组肺动脉顺应性指数最低(χ2=83.390,P<0.001)。结论:在中大型室间隔缺损患者,肺动脉压、肺动脉顺应性与年龄的相关关系均不密切。肺动脉顺应性指数可作为评价中大型室间隔缺损患者发生高压性肺血管病变的参数,且不同个体差异很大。

Objective： To investigate the relationship between pulmonary arterial systolic pressures （PASP）and its data ages in patients with moderate-sized or large ventricular septal defect （VSD） using echocardiography, and to discuss the potential value of pulmonary arterial compliance index（PACI） predicting severe obliterative pulmonary vascular disease. Method： A total of 349 patients with moderate-sized or large VSD were examined with Doppler echocar-diography. VSD diameters were measured with two-dimensional echocardiography and trans-VSD pressure gradients were measured with Doppler echocardiography. PASPs, VSD area indices and PACIs were calculated using formulas. In addition, totally 349 patients were divided into 3 groups by symptom and sign as well as 4 groups by age. The datas of different groups were analyzed with SPSS 10.0. Result： 1. Removing VSD area index factor, partial coefficient of correlation between PASP and ages was 0.11 （respectively, P 〈 0.001 ）. And removing age factor, partial coefficient of correlation between PASP and VSD area indices was 0.49 （respectively, P 〈 0.001 ）. Kendall＇s tua-b test was performed to PACIs and ages, and showed no significant correlation （ r = 0.04, P 〉 0.05 ）. 2. Friedman test was performed to different groups, and showed that PACIs were significantly higher in subjects with 15 or elder ages compared with other groups （X^2= 8.432, P 〈 0.05）, moreover, PACIs were significantly higher in group surgery prognosis（X^2= 83. 390, P 〈0.001 ）. Conclusion： contraindication and group bad prognosis compared with group good ＇ PASP and PACI is not significantly corelated with age. Although there is positively lower relationship of PASP and VSD area index. PACI is considered a parameter of obliterative pulmonary vascular lesions that varies greatly from individial to individial.