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法洛四联症根治术中右心室-肺动脉测压与术后超声心动图压力阶差的相关性研究

Relationship between the right ventricle-pulmonary artery pressure gradients measured by direct needle puncture and estimated by echocardiography after repair of tetralogy
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摘要 目的 总结我院近两年法洛四联症根治术右心室流出道处理经验,研究右心室测压和超声心动图压力阶差的相关性.方法 回顾我院2016年1月至2018年1月法洛四联症根治手术的连续36例患者临床资料.术中停体外循环后直接测量右心室、肺动脉压力;所有患者术中、术后查超声心动图.结果 全组男性18例,女性18例,手术中位年龄0.8(0.2~37.0)岁,中位体重8.4(3.7~61.5)kg.10例患者(27.8%)保留肺动脉瓣环,25例(69.4%)行跨瓣补片,1例(2.8%)肺动脉闭锁患者采取心外管道.术毕直接测量右心室-肺动脉压力阶差(7.6±6.9) mm Hg;右心室/左心室压力比值0.52±0.15.术中超声心动图检查肺动脉瓣上压力阶差(13.4±12.3)mm Hg,显著高于直接测量值(P=0.02).术中直接测量跨肺动脉瓣压差与出院前心超跨肺动脉瓣压差显著相关,相关系数0.43 (P<0.01).本组患者无手术死亡,无再次手术干预,ICU停留时间5(2~17)d,术后住院时间12(7~66)d.保留肺动脉瓣环患者ICU停留时间及住院时间均较短[(4.2±1.7)d,(10.4±3.7)d],与跨瓣补片患者相比未见统计学差异[(6.4±3.8)d,(16.4±12.0)d;P=0.08及P=0.06].随访0.9(0.2~2.0)年,无死亡及再次干预,半年后随访超声心动图提示肺动脉瓣上压差较出院时显著降低[(8.5±1.7)mm Hg,P=0.03].结论 法洛四联症患者术中测量的右心室-肺动脉压力阶差与术后出院前超声心动图估测压力显著相关;但术中经食管超声心动图可高估右心室-肺动脉压力阶差,该压力阶差在术后随访过程中逐渐下降. Objective To summarize the surgical experiences of right ventricular outflow tract in Tetralogy of Fallot (TOF) repair, and to investigate relationship between the right ventricle-pulmonary artery pressure gradi- ents measured by direct needle puncture and estimated by echocardiography. Methods Thirty-six consecutive pa- tients with TOF repair from Jan 2016 to Jan 2018 were retrospectively reviewed. The pressures in right ventricle (RV) and pulmonary artery(PA) were measttred after cardiopulmonary bypass was ceased. All patients had intra- and post-operative echocardiography. Results There were 18 males (50%), and the median age at operation was 0.8 year, and the median body weight was 8.4 kg. Ten patients(27.8%) had pulmonary annulus preserved, while 25 patients(69.4%) had trans-annulus patch, and the other one patient had RV-PA conduit connection. The pres- sures measured by direct needle puncture indicated the pressure gradient (PG) of RV-PA was (7.6±6.9)mm Hg, and the ratio of right ventricular pressure over left ventricular pressure(RVP/LVP) was 0.52±0.15. The PG of RV- PA estimated by intraoperative trans-esophageal echocardiography was ( 13.4±12.3 ) mm Hg, and it was significant-ly higher than the PG by direct measurement (P=0.02). The intraoperative RV-PA PG of direct measurement was significantly correlated with that obtained from pre-discharged echocardiography (r=0.43, P〈0.01 ). Overall, there was no death and no reintervention. The median ICU stay was 5 (range 2-17 )days, and the postoperative stay was 12 (range 7-66)days. Those who had pulmonary annulus preserved had shorter ICU stay and postopera- tive stay, and the difference was no significant when compared to those who had trans-annulus patch. The patients were followed 0.9 (0.2-2.0)years, and there was no death and reintervention. The most recent echocardiography revealed a decreased RV-PA gradient when compared to the pre-discharged gradient [ ( 8.5± 1.7 ) mmHg, P=0.03 ]. Conclusion The intraoperative RV-PA PG of direct measurement is significantly correlated with the gradient from pre-discbarged echocardiography after TOF repair; however, the intraoperative transesophageal echocardiography may over-estimate the RV-PA gradient, and the gradient may decrease during follow-up.
作者 朱家全 丁士骜 张丽 姚丽萍 徐振 鲍春荣 丁芳宝 梅举 ZHU Jia-quan;DING Shi-ao;ZHANG Li(Department of Cardiothoracic Surgery and Clinical Research Unit,Shanghai Xinhua Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200092,China)
出处 《中国心血管病研究》 CAS 2018年第8期731-735,共5页 Chinese Journal of Cardiovascular Research
基金 国家自然科学基金(项目编号:81600219) 上海交通大学医学院附属新华医院院级临床研究项目(项目编号:15LC03)
关键词 法洛四联症 外科治疗 压力阶差 Tetralogy of Fallot Surgical repair Pressure gradient
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