小儿先天性心脏病伴重度肺动脉高压手术指征

Operative indication in children with congenital heart defect and severe pulmonary hypertension

目的 探讨先天性心脏病 (先心病 )伴重度肺动脉高压 (肺高压 )患儿手术指征的判定标准。方法 38例经手术治疗后早期肺动脉压降至正常的患儿作为可逆性肺高压组 (简称RPH组 ) ,1 2例经手术治疗后持续性肺高压的患儿作为不可逆性肺高压组 (简称IPH组 ) ,对比两组血流动力学指标。结果 两组肺 体动脉收缩压比值 (Pp Ps) ,肺 体血管阻力比值 (Rp Rs) ,肺 体循环血流量比值 (Qp Qs)及动脉血氧饱和度 (SaO2 )差异均有显著意义。若判定先心病伴重度肺高压手术指征为下列 5项 :年龄小于 2岁 ,Pp Ps<1 .0 ,Rp Rs<0 .7,Qp Qs>1 .5,SaO2 >0 .9,则本研究中RPH组 38例患儿均符合上述 3项或 3项以上 ,而IPH组仅 1例患儿符合上述 3项指标。结论 先心病伴重度肺高压存在上述 5项指标中3项或 3项以上。判定患儿有手术指征 ,可疑者应进一步作扩血管试验和肺组织病理检查 。

Objective To determine the standard for operative indication of severe pulmonary hypertension(PH)in children with congenital heart defect (CHD).Methods The children with CHD and severe PH were divided into two groups.Reversible PH group consisted of thirty eight cases who accepted surgical repair for their cardiac defects and PH was reversed dramatically after operation,Irreversible PH group consisted of twelve cases who accepted surgical repair while their pulmonary artery pressure sustains a higher level postoperatively.Compare the bloodstream parameters of the two groups.Results Significant differences were found in Pp/Ps,Rp/Rs,Qp/Qs,and SaO 2 between the two groups.If such five parameters as being younger than two years of age,below one for Pp/Ps ratio,below seventy percent for Rp/Rs ration,more than one point five for Qp/Qs ratio and higher than ninety percent for SaO 2 were used to decide the operative indication,three or more parameters existed in all thiry eight cases in reversible PH group but three parameters existed in only one case in ireversible PH group.Conclusions If a child with CHD and severe PH has three or more parameters,the suspected should be done further pulmonary vasodilative test or lung biopsy to decide the operative indication.