血液动力学检测及肺小动脉楔入造影对先天性心脏病肺动脉高压的评价

Evaluate the pulmonary hypertension secondary to congenital heart diseases with the hemodynamic measurement and pulmonary wedge angiography

目的 探讨血液动力学检测及肺小动脉楔入造影在评价先天性心脏病 (简称先心病 )肺动脉高压 (简称肺高压 )程度和性质中的价值。方法 采用血液动力学检测及肺小动脉楔入造影对48例先心病患儿进行检查 ,并与手术结果进行比较分析。结果 器质性肺高压组肺小动脉楔入平均压明显低于重度非器质性肺高压组 ,分别为 (11± 5 )mmHg(1mmHg =0 .133kpa)和 (16± 6 )mmHg。肺小动脉楔入造影中 ,随着肺血管病变程度的增加 ,肺循环时间逐渐延长 ,肺组织毛细血管充盈程度逐渐减少 ,器质性肺高压组表现得更加明显。肺小动脉逐渐变细率与肺动脉收缩压、肺小动脉阻力成负相关 ,相关系数分别为 - 0 .6 1(P <0 .0 0 1)和 - 0 .5 5 (P <0 .0 0 1)。肺循环时间与肺动脉收缩压、肺小动脉阻力成正相关 ,相关系数分别为 0 .76 (P <0 .0 0 1)和 0 .77(P <0 .0 0 1)。结论 肺小动脉楔入平均压检测结合肺小动脉楔入造影有助于较好地评价先心病肺高压的程度和重度肺高压的性质。

Objective Pulmonary hypertension (PH) is one of the common and severe complications in congenital heart diseases(CHD),and usually influences the results and prognosis of surgery operations. For evaluating accurately the degree and feature of PH secondary to CHD, the hemodynamic measurement and pulmonary wedge angiography (PWA) were performed in patients with CHD. Methods Hemodynamic measurement and PWA were performed in 48 patients with CHD, which included 26 boys and 22 girls, aged from 0.7 to 12.6 years [average (6.3±3.0) years]. CHD included 13 patients with VSD, 2 with ASD, 1 with PDA, and 32 with other abnormalities. Results There was no significant difference in pulmonary artery wedge mean pressure (PAWMP) between the moderate and severe dynamic groups [(15±4) mm Hg, and (16±6) mm Hg, P >0.05]. PAWMP was lower in organic group than in severe dynamic group [(11±5) mm Hg and (16±6) mm Hg, P <0.05]. PWA revealed that the rate of tapering (ROT) was significantly higher in normal group than in PH group [(14.5±3.0) mm vs (10.4±2.7) mm, P <0.001], and there was no significant difference among mild, moderate and severe groups [(11.6±2.6) mm, (11.5±2.4) mm and (9.4±2.7) mm,respectively, P >0.05]. There was no significant difference between severe dynamic and organic groups in ROT [(10.2±2.8) mm vs (8.6±2.4) mm, P >0.05]. ROT correlated negatively with pulmonary artery systolic pressure (PASP) and pulmonary arteriole resistance (PAR, the correlation coefficient was -0.61 and -0.55, respectively, P <0.001). In PWA, the pulmonary circulation time (PCT) was prominent longer in PH group than in normal group [(1.99±0.47) sec vs (1.47±0.18) sec, P <0.01], and showed significant differences among mild, moderate and severe groups [(1.39±0.14) sec, (1.81±0.15) sec and (2.25±0.50) sec, respectively, P <0.01], and between severe dynamic and organic groups (2.02±0.34) sec and (2.50±0.54) sec, respectively, P < 0.05. PCT correlated positively with PASP and PAR (the correlation coefficient was 0.76 and 0.77, respectively, both of P <0.001). In PWA, there was a significant difference between normal and PH groups in background haze (BH, P <0.05), and there were also significant differences among mild, moderate and severe groups, and there was prominent difference between severe dynamic and organic groups (both of P < 0.05). Conclusion PAWMP combined with PWA may help to evaluate the degree of PH and the nature of severe PH in CHD.