并发主肺侧支的Fallot四联症术后通气功能的改变

Ventilatory response in patients with corrected tetraology of Fallot with major aortopulmonary collateral arteries

目的:研究侧支循环对Fallot四联症患者根治术后心肺功能的影响。方法:我们研究了23例Fallot四联症并发主肺侧支的患者(组A),30例没有侧支的Fallot四联症患者(组B),37例行室间隔缺损或房间隔缺损修补的患者(组C)。各组患者于术前和术后一年进行肺功能测试和运动心肺功能,分析肺活量、最大摄氧量、氧脉搏、死腔/潮气量比等。结果:肺功能结果显示各组间第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、分钟通气量、分钟通气量占预计值百分比无显著性差异,在组A和组B用力肺活量、用力肺活量占预计值百分比与组C相比差异有显著性(P<0.01),组A的FEV1/FVC%显著高于组B和组C(P<0.01)。运动心肺试验显示组A的最大运动功率、峰值运动时的分钟通气量、呼吸商、最大摄氧量、无氧阈、最大氧脉搏显著低于组B和组C(P<0.01),而CO2呼吸当量明显高于组B和组C(P<0.01)。结论:组A与组B、组C相比,表现出更显著的限制性通气功能损害,因此术前需积极处理主肺侧支。

AIM： To investigate the lung function and cardiopulmonay exercise （CPX） performance in patients with corrected tetralogy of Fallot with major aortopulmonary collateral arteries. METHODS： Routine lung function and CPX tests were performed in 23 patients with tetralogy of Fallot with major aort- opulmonary collateral arteries （group A）, 30 patients with tetralogy of Fallot without major aortopulmo- Mary collateral arteries （group B）, and 37 patients with ventricular septal defect or atrial septal defect （group C）. The study was performed 1 year after corrective heart surgery. RESULTS： No significant differences were observed in FEV1, FEV1% pred, MVV, and MVV% pred among group A, group B and group C. FVC and FVC% pred decreased significantly in group A compared with those in group B and group C （P 〈0. 01 ）. In group A, FEV1/FVC% was the highest （P 〈 0. 01 ）. CPX showed that WR max, MV at peak exercise, RQ, VO2 max/kg, AT and VO2/HRmax in group A were the lowest （P 〈 0.01）, whereas VE/VCO2 at peak exercise was the highest （P 〈 0. 01 ）. CONCLUSION： There is marked restrictive ventilatory impairment in patients with tetralogy of Fallot with major aortopulmonary collateral arteries. Early repair of major aortic pulmonary collateral arteries may prevent progression of the impaired ventilatory response to exercise in these patients.