体-肺动脉分流术后肺动脉发育多因素分析

The multiple factors analysis for the development of pulmonary arteries after systemic-pulmonary shunt

目的分析影响体-肺动脉分流术后肺动脉发育的相关因素,以期提高手术效果。方法选取自2009年1月至2015年6月沈阳军区总医院心血管外科收治的142例患者行体-肺动脉分流术。术后6个月,观察患者肺动脉指数(PAI)。结果本组142例患者均获得随访6~36个月随访,平均随访11个月。随访期间,所有患者肺动脉及其分支都有不同程度的发育。其中,再次接受矫治手术93例(65.5%),继续等待下一步治疗49例(34.5%)。术后6个月,PAI为(177.1±33.3)mm^2/m^2,与术前(124.5±24.6)mm^2/m^2比较,差异有统计学意义(P<0.01);PAI变化率0~129.8%,平均变化率为(39.7%±24.1%)。手术年龄、病种、大的主-肺侧支动脉(MAPCA)数量和手术方式是影响肺动脉指数变化率的独立相关因素;手术年龄和术前病种是影响再次接受矫治手术的独立相关因素。结论患者年龄和手术方式是体-肺动脉分流术后肺动脉发育的主要影响因素,尽早行体-肺动脉分流术能提高接受再次矫治手术的概率。

Objective To explore the influencing factors associated to the development of pulmonary arteries in patients after systemic-pulmonary shunt. Methods A retrospective study was performed on 142 patients that underwent systemic-pulmonary shunts in the General Hospital of Shenyang Military Command from January 2009 to June 2015. After 6 months,the pulmonary artery index（ PAI） of patients was observed. Results All 142 patients received follow-up for mean 11 months（ ranged from 6 to 36 months）. During the follow-up period,the pulmonary artery and its branches of all the patients had different levels of development. Among them,93 patients（ 65. 5%） underwent the second repair operation while the other 49patients（ 34. 5%） were still waiting for the next operation. After 6 months,the total pulmonary artery index increased from a mean value of（ 124. 5 ± 24. 6） mm2/ m2to（ 177. 1 ± 33. 3） mm2/ m2,and the difference was statistically significant（ P〈0. 01）. PAI rate of change was 0 to 129. 8%,and the mean rate was（ 39. 7% ± 24. 1%）. The age,disease,and large-main pulmonary collateral arteries（ MAPCA） number and operation method were independently related factors affecting pulmonary index change rate. The age and operative method were the independent influencing factors of the second repair operation.Conclusion The age and operative method are the major influencing factors. If the patients undergo the systemic-pulmonary shunt as soon as possible,they will have more probability to undergo the second repair operation.