肺小动脉楔入造影对先天性心脏病患儿肺动脉高压的评估价值

The evaluation by pulmonary wedge angiography of children with pulmonary artery hypertension associated with congenital heart disease

目的通过对肺小动脉行肺小动脉楔入造影(PWA),分析PWA对先天性心脏病(CHD)相关肺动脉高压(PAH)的评估价值。方法对50例CHD患儿进行心导管及PWA检查,根据肺动脉压力分为肺动脉压力、阻力正常组[A组,15例,肺平均动脉压(m PAP)≤25 mm Hg(1 mm Hg=0.133 k Pa)、全肺阻力(PVR)<300 dyne·s·cm^5],肺动脉压力升高、阻力正常组(B组,24例,m PAP>25 mm Hg、PVR<300 dyne·s·cm^5),肺动脉压力、阻力均升高组(C组,11例,m PAP>25 mm Hg、PVR≥300 dyne·s·cm5)。观察肺小动脉逐渐变细速率(ROT)、肺循环时间(PCT)、肺毛细血管充盈度(BH)与血流动力学指标的相关性。结果 C组肺小动脉ROT显著小于A组[(8.16±2.14)mm比(18.70±2.25)mm]、B组[(8.16±2.14)mm比(13.83±3.45)mm],差异均有统计学意义(P=0.000);B组和C组的ROT与m PAP无相关性,C组ROT与PVR负相关(相关系数r=-0.606,P<0.05)。C组PCT指数显著大于A组[(1.50±0.37)s/m^2比(1.08±0.23)s/m^2]、B组[(1.50±0.37)s/m^2比(1.22±0.32)s/m^2],差异均有统计学意义(P<0.05);B组和C组PCT指数与m PAP无相关性,C组PCT指数与PVR正相关(相关系数r=0.783,P=0.01)。三组患者毛细血管充盈度比较,差异均有统计学意义(F=23.697,P=0.000),其中B组、C组与A组相比毛细血管充盈度显著减少(P<0.05)。结论 PWA能定量评估CHD相关PAH患者的肺血管床。

Objective To study pulmonary wedge angiography（ PWA） with hemodynamic the evaluation of children with congenital heart disease and pulmonary artery hypertension（ PAH）. Methods Hemodynamic measurement and pulmonary wedge angiography were performed in 50 children with congenital heart disease. Comparison and analysis were made from the data obtained from PWA and catheterization.Results After PWA,the patients were categorized into 3 groups according to the measured hemodynamics parameters： group A [n = 15,patients with normal mean pulmonary artery pressure（ m PAP ≤25 mm Hg）and normal pulmonary vessel resistance（ PVR 300 dyne·s·cm^5） ],group B [n = 24,patients with PAH（ m PAP 25 mm Hg） but normal PVR]and group C（ n = 11,patients with PAH and elevated PVR（ PVR≥300 dyne·s·cm^5）. Rote of tapering（ ROT） was significant lower in group C than in group A and B（ F =42. 559,P〈0. 05）. Pulmonary circulation time（ PCT） was higher in group C than in group A and B（ F =6. 037,P〈0. 05）. ROT correlated negatively with PVR（ r =- 0. 606,P〈0. 05）. PCT index correlated positively with PVR（ r = 0. 783,P = 0. 01）. There was no significant correlation between PCT and mean pulmonary artery hypertension（ m PAP）. Conclusions PWA may help to make quantitative analysis of the pulmonary vascular status in patients with congenital heart disease.