全腔静脉肺动脉连接术后跨肺压的监测方法评估

Evaluation of methods for monitoring transpulmonary gradien after total cavopulmonary connection surgery

目的拟通过超声心动图估测的跨肺压与实测跨肺压进行对比来探讨估测跨肺压梯度(transpulmonary gradient,TPG)是否可靠。方法回顾性分析上海儿童医学中心心胸外科数据库,纳入2015年1月至2018年12月进行全腔静脉肺动脉连接手术,具有血流动力学监测及超声检查结果的患者,根据公式分别计算出TPG,进行一致性检验分析。结果最终入选27例,其中男16例,女11例,年龄(4.0±1.6)岁,体重(15.2±3.3)kg,身高(99.1±11.2)cm。其中右心室双出口9例(33.3%),肺动脉闭锁7例(25.9%)。血流动力血监测TPG为5~16(10.1±3)mmHg,超声学参数估算TPG为5.8~20.3(11±3.3)mmHg,其组内相关系数分析显示ICC值为0.117<0.4,P=0.277,两者结果不一致。结论在围术期通过全腔静脉肺动脉连接术管道开窗估测的TPG并不准确,且较实际值高,因此围术期仍推荐有创血流动力学监测。

Objective To explore the reliability of estimated transpulmonary gradient(TPG)by comparing the measured TPG with the estimated TPG in echocardiography.Methods The cardiothoracic surgery database of Shanghai Children′s Medical Center was reviewed.Children with hemodynamic monitoring and ultrasound findings who underwent total cavopulmonary connection between January 2015 and December 2018 were included.TPG was calculated separately according to the formula.Intraclass correlation efficient was used for consistency test.Results Finally,27 patients were selected,including 16 males and 11 females with age(4.0±1.6)years old,weight(15.2±3.3)kg and height(99.1±11.2)cm.There were nine cases(33.3%)of right ventricular double outlet and seven cases(25.9%)of pulmonary atresia.For hemodynamic blood monitoring,TPG was 5-16(10.1±3)mmHg,and its echocardiography parameters were estimated as 5.8-20.3(11±3.3)mmHg.The ICC value was 0.117 which was less than 0.4(P=0.277).Conclusion TPG estimated by total cavopulmonary connection pipe window during perioperative period is inaccurate and higher than actual value,so invasive hemodynamic monitoring is still recommended during perioperative period.