超声评价肺血减少型复杂先天性心脏病双向Glenn术后肺血管发育的临床价值

Echocardiographic assessment of pulmonary artery development in patients with complex congenital heart disease and reduced pulmonary flow underwent bidirectional Glenn shunt surgery

目的:探讨超声心动图评价肺血减少型复杂先天性心脏病(先心病)双向Glenn分流术后肺血管发育的临床应用价值。方法:应用二维经胸超声心动图测量101例复杂发绀型先心病患儿双向Glenn分流术前后左、右肺动脉内径,同时测量术前、术后经皮血氧饱和度,评价其术后肺血管发育。根据有无肺动脉前向血流将患儿分为肺动脉闭锁组(30例)和肺动脉狭窄组(71例);另分为婴幼儿组(年龄≤3岁,51例)和儿童组(年龄>3岁,50例),比较各组内及组间手术前后肺动脉分支内径及血氧饱和度变化。结果 :术后应用超声心动图随访12～36个月,左、右肺动脉内径及血氧饱和度较术前有不同程度改善。肺动脉狭窄组较肺动脉闭锁组术后肺动脉生长发育及血氧饱和度的改善更明显;婴幼儿组肺动脉发育及血氧饱和度改善情况优于儿童组(P<0.01)。应用超声定量的肺动脉分支发育与临床血氧相关性回归分析结果满意(P<0.001)。结论:肺血减少型复杂先心病患儿施行双向Glenn分流术后,可在不增加右心室前负荷情况下增加肺血流,促进患者肺动脉血管发育,提高血氧饱和度。超声心动图对术后定量随访评估肺血管发育,评估预后有重要的临床应用价值。

Objective：To evaluate the clinical value of echocardiography in assessment of pulmonary artery development in patients with complex congenital heart disease（CHD） underwent bidirectional Glenn shunt surgery.Methods： Echocardiography was preformed to measure the diameter of pulmonary branches in 101 patients underwent bidirectional Glenn shunt procedure before and after th surgery.The percutaneous blood oxygen saturation was measured at the same time.Patients were divided into two groups,pulmonary atresia（PA） group（n=30） and pulmonary stenosis（PS） group（n=71）,according to the presence of pulmonary artery blood.Also according to the age,patients were divided into infant group（age ≤3;n=51） and children group（age 3;n=50）.The changes of pulmonary artery diameter and blood oxygen saturation were compared intra and inner groups.Results： 101 patients were followed up（FU） from12 to 36 months after bidirectional Glenn shunt procedure,with a median FU time was 25months.The diameter of pulmonary artery and percutaneous blood oxygen saturation were improved after the surgery in all patients.The improvement in PS group was much better than that of in PA group;similar results was seen in the infant group（P0.05）.The regression analysis results showed good correlation between the pulmonary artery measured by echocardiography and percutaneous blood oxygen saturation before and after surgery.（P0.01） Conclusion： Bidirectional Glenn shunt procedure can promote the pulmonary vascular development and improve oxygen saturation without increasing right ventricular preload.Echocardiography is reliable in assessment of the growth of pulmonary vascular in long-term follow-up.