高海拔地区儿童肺高压临床分析

Clinical analysis of children with pulmonary hypertension at high altitude

目的探讨高海拔地区儿童肺高压(pulmonary hypertension,PH)的临床特征,以提高高海拔地区儿童PH的早期诊治水平。方法回顾性分析阿坝州人民医院2008年8月至2011年9月2392例来自高海拔地区的住院患儿中诊断PH并经超声心动图检查证实为肺动脉压力升高病例的年龄、性别、临床主要症状、体征及超声心动图估测的肺动脉收缩压(sPAP),按不同海拔高度进行分组统计,对不同组间经多普勒超声心动图三尖瓣返流速度估测的sPAP进行比较。结果①本组患儿共发生PH 139例(5.8%),其中女65例,男74例,年龄(1.7±0.52)岁。海拔3000米以上PH发生率(9.28%)明显高于海拔3000米以下PH发生率(1.07%),差异有统计学意义(P<0.05)。②主要临床表现为呼吸困难(61.9%),发绀(73.3%)。sPAP为(63.5±21.2)mmHg,心功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别占3.6%、8.6%、53.2%、34.6%。③治疗后PH患儿三尖瓣返流速率由(3.74±1.84)m/sec下降至(3.15±1.67)m/sec,sPAP由(63.5±21.2)mmHg下降至(47.3±18.7)mmHg,差异均有统计学意义(P<0.01)。结论不同海拔高度PH的发生率有差异,主要临床表现是呼吸困难和发绀,超声心动图和心功能评定对早期诊断和治疗PH非常必要。

Objective To investigate the clinical features of pulmonary hypertension（PH） of children at high altitude in order to improve the early diagnosis and treatment of PH. Methods This study was based on a retrospective analysis of 2392 hospitalized children in Aba District People＇s Hospital from August 2008 to September 2011. The children were diagnosed as PH and confirmed by ultrasound cardiogram. The age, sex, clinical main symptoms, signs and systolic pulmonary arterial pressure （sPAP） estimated by ultra- sonic cardiogram were recorded. The patients were grouped according to different altitude. The sPAP levels estimated by Doppler echo- cardiography tricuspid regurgitation among the groups were compared. Results ①One hundred and thirty-nine （5.8%） patients （65 girls and 74 boys） with age of （ 1.7 ± 0. 52 ） years old were found to have PH. Obviously, there were more patients who live in 3000 me- ters above sea level（9. 28% ）than those living under 3000 meters elevation（ 1.07% ）. The difference was statistically signifieant（P 〈 0. 05 ）. ②The most common clinical manifestations of PH were dyspnea on exertion （61.9%）and eyanosis （73.3 % ）. The mean sPAP level of these patients was （63.5 ±21.2）mmHg. The patients with heart function classification Ⅰ, Ⅱ, Ⅲ, Ⅳ were 3.6%, 8. 6% ,53.2% and 34. 6% ,respectively. ③fter treatment,tricuspid regurgitation veloeity was dropped from （3.74 ± 1.84）m/see to （3.15 ± 1.67） m/sec,The sPAP was dropped from （63.5 ± 21.2） mmHg to （47. 3 ± 18.7） mmHg. The difference is statistically significant（P 〈 0. 01 ）. Conclusions There are differences in rates of PH at different altitudes. The most common manifestations are dyspnea on exer- tion and cyanosis. Doppler echocardiography and PH functional classification are necessary for early diagnosis and treatment of PH.