超声检测腺苷急性血管扩张试验在先天性室间隔缺损合并重度肺动脉高压中的应用

Applied intravenous adenosine infusion in congenital ventricular septal defect with severe pulmonary hypertension by Doppler echocardiography

目的应用彩色多普勒超声心动图评价腺苷急性血管扩张试验在先天性室间隔缺损合并重度肺动脉高压中的应用价值。方法选取先天性室间隔缺损并重度肺动脉高压患者68例,肘静脉注射腺苷75μg.kg-1.min-1,应用彩色多普勒超声心动图检测主动脉平均压、肺动脉平均压、肺动脉收缩压、肺动脉舒张压、肺血管阻力、体循环阻力、肺循环阻力/体循环阻力比值、肺动脉/主动脉收缩压比值、肺循环/体循环血流量比值,注射5min后,与用药前比较,肺血管阻力下降>30%和肺动脉平均压下降>10%为急性血管扩张试验阳性。结果肺动脉平均压、肺动脉压、肺血管阻力、肺循环阻力/体循环阻力比值、肺动脉/主动脉收缩压比值用药后较用药前均明显下降(P<0.05),肺循环/体循环血流量比值明显增加(P<0.05),体循环阻力下降不明显(P>0.05),其中39例急性血管扩张试验阳性者,通过临床药物降压治疗有效后成功手术;29例急性血管扩张试验阴性者继续降压治疗无效并非手术适应证而行保守和对症治疗。结论腺苷选择性作用于肺血管,在先天性室间隔缺损合并重度肺动脉高压中,是急性血管扩张试验中较好的药物。

Objective To evaluate the value of adenosine-acute-vasodilatation test in patients with congenital ventricular septal defect （VSD） and severe pulmonary hypertension （PH） by color Doppler echocardiography. Methods 68 patients with congenital VSD and severe PH were studied. Mean systemic arterial pressure, pulmonary arterial mean pressure （PAMP）, pulmonary arterial systolic pressure （PASP）, pulmonary .artery diastolic pressure （PADP）, pulmonary vascular re- sistance （PVR）, systemic vascular resistance （SVR）, ratio of pulmonary/systemic vascular resistance （Rp/Rs）, ratio of pul- monary/systemic Systolic pressure （Pp/Ps）, and ratio of pulmonary/systemic blood flow （QP/Qs） were estimated by color Doppler eehocardiography before and five minutes after intravenous infusion of adenosine （75 μg·kg^-1·min^-1）. A positive test was defined as PVR decreased greater than 30% and PAMP over 10%, compared with baseline. Results Intravenous infusion of adenosine significant decrease in PAMP, PASP, PADP, PVR, Rp/Rs and Pp/Ps（ P 〈 0.05）;at the same time, significantly improved Qp/Qs（ P 〈 0.05）. There was nO significant decrease in SVR（ P 〉 0.05）. 39 patients who were classified as positive test results tmderwent uneventful surgical procedures, while 29 patients with negative test results responded poorly to approaches for reducing pulmonary artery pressure. Conclusion Adenosine, being a selective pulmonary vasodilator, is an ideal agent of acute dilatation test in patients with VSD and severe pulmonary hypertension.