风湿性心脏病二尖瓣狭窄合并肺动脉高压者血管力学特性的变化

A study on mechanical properties of pulmonary artery in pulmonary hypertension secondary to rheumatic mitral stenosis

目的 探讨风湿性心脏病 (风心病 )二尖瓣病变合并肺动脉高压 (肺高压 )的肺血管力学特性的变化规律。方法 借助右心导管技术和利用压力波形面积确定动脉顺应性的改进方法 ,测定肺血流动力学和肺血管顺应性。结果 ①二尖瓣狭窄 (MS)为主合并肺高压组的肺动脉血管零压 (C0 )较正常对照组明显下降 [(9 98± 2 2 3)ml mmHg对 (2 40± 0 6 8)ml mmHg ,P <0 0 1],风心病合并严重肺动脉高压 (mPAP≥ 35 0 0mmHg)比轻度肺动脉高压 (mPAP <35 0 0mmHg)下降更为明显 [(2 78± 0 83)ml mmHg对 (2 0 4± 0 5 5 )ml mmHg,P <0 0 5 ];②MS组术前mPAP与反映血管壁固有结构的C0 之间呈显著负相关(r=- 0 745 ,P <0 0 5 ) ;③分别比较手术后应用硝普钠 (0 5 μg·kg- 1 ·min- 1 )观察轻度肺高压组和MS重度肺高压组的肺循环血流动力学和血管顺应性的变化 ,两组病人用药后PAP、肺血管阻力 (PVR)均显著下降 (P <0 0 1) ,轻度肺高压组C0 和肺动脉平均压 (Cm)均明显升高 (P <0 0 1) ;而MS组重度肺高压组C0 用药前后无明显变化 [(2 35± 1 2 4)ml mmHg对 (2 2 4± 1.5 3)ml mmHg ,P >0 0 5 ) ,Cm由于肺动脉压下降而呈显著升高 [(1 5 1± 0 5 9)ml mmHg对 (1 81± 0 77)ml mmHg ,P <0 0 5 ]。结论 风?

Objective: To evaluate the mechanical properties of pulmonary artery in patient with rheumatic valvular disease. Method: This study consisted of 27 patients with rheumatic valve disease comparing with 8 normal controls. Pulmonary pressure curves were obtained by right heart catheterization. Pulmonary arterial resistance and compliance were calculated.Results: (1)As compared to the controls, the pulmonary arterial compliance in mitral stenosis(MS) with pulmonary hypertension was significantly lower (P<0 01). (2)Linear correlation analysis showed that preoperative mPAP was correlated closely with C 0 in the group of MS (r=-0 745,P<0 05). (3)PAP and PVR decreased significantly after infusing sodium nitroprusside(0 5μg·min -1 ·kg -1 ) in both MS with mild pulmonary hypertension(mPAP<35?mm?Hg) and MS with severe pulmonary hypertension(mPAP≥35?mm?Hg) groups(P<0 01). C 0 and Cm increased significantly in group of MI with mild pulmonary hypertension. Whereas C 0 of MS with severe pulmonary hypertension didn't change significantly[(2 35±1 24) vs (2 24±1 53)?ml/mm?Hg,P>0 05]. Cm increased significantly with decreasing of mPAP[(1 51±0 59) vs (1 81±0 77)?ml/mm?Hg]. Conclusion: The results showed different degree of pulmonary vascular remodeling in the rheumatic valvular disease with pulmonary hypertension. The degree of pulmonary arterial changes in patients with mitral stenosis is a major factor affecting the level of preoperative pulmonary arterial pressure. MS patients with pulmonary hypertension may have low response to the vasodilator.