非紫绀型先天性心脏病儿童术前潮气呼吸肺功能研究

Study on pulmonary function of tidal respiration before operation in children with acyanotic congenital heart disease

目的:探讨非紫绀型先天性心脏病儿童术前潮气呼吸肺功能相关参数改变及其影响因素。方法:选择非紫绀型先天性心脏病儿童107例为研究对象,健康体检儿童48例为对照组,分别进行潮气呼吸肺功能检查。先天性心脏病儿童介入术中测定肺动脉平均压,并分别采集上腔静脉、肺动脉及主动脉(或左心房)血检测血氧饱和度及血红蛋白;按肺动脉平均压分为非肺高压组65例和肺高压组42例,并计算血流动力学指标。将3组儿童肺功能进行比较,对先天性心脏病儿童血流动力学指标与肺功能参数进行相关性分析。结果:从对照组、非肺高压组到肺高压组,每分钟通气量(MV)、潮气呼气峰流速(PTEF)、潮气峰流速/潮气量(PF/VE)水平逐渐增高,达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、达峰容积(VPTEF)和达峰容积比(VPEF/VE)水平则逐渐降低,差异有统计学意义(P<0.05)。肺动脉平均压与PF/VE、RR、Ti/Te呈正相关(r=0.31、0.25、0.257,P<0.05),与TPTEF、Te呈负相关(r=-0.26、-0.283,P<0.05);肺血管阻力与PF/VE、RR、Ti/Te呈正相关(r=0.306、0.247、0.218,P<0.05),与MV、Ti、Te呈负相关(r=-0.205、-0.207、-0.264,P<0.05)。结论:非紫绀型先天性心脏病儿童存在阻塞性通气功能障碍,随着肺动脉平均压力及肺血管阻力的升高,可合并限制性通气功能障碍。

Objective:To explore the changes of tidal breathing pulmonary function parameters and its influence factors in children with acyanotic congenital heart disease before operation.Method:The 107 children with acyanotic congenital heart disease were selected as the research objects,another 48 healthy children were selected as the control group.Tidal breathing pulmonary function test was performed in each groups.Mean pulmonary artery pressure was measured during interventional surgery in children with congenital heart disease,and blood oxygen saturation and hemoglobin were measured in the superior vena cava,pulmonary artery and aorta(or left atrium),respectively.Children with congenital heart disease were divided into non-pulmonary hypertension group(65 cases)and pulmonary hypertension group(42 cases)according to the mean pulmonary artery pressure,and the hemodynamic parameters were calculated.The lung function of the three groups of children were compared,and the correlation between hemodynamic parameters and lung function parameters was analyzed in children with congenital heart disease.Result:From the control group,non-pulmonary hypertension group to pulmonary hypertension group,the minute ventilation(MV),peak tidal expiratory flow(PTEF),ratio of peak tidal expiratory flow and Tidal volume(PF/VE)level gradually increased,while the levels of time to peak tidal expiratory flow(TPTEF),time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),volume to peak tidal expiratory flow(VPTEF),and volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)gradually decreased,with statistically significant differences(all P<0.05).The mean pulmonary artery pressure was positively correlated with PF/VE,RR and Ti/Te(r=0.31,0.25,0.257,all P<0.05),and negatively correlated with TPTEF and Te(r=-0.26,-0.283,all P<0.05).Pulmonary vascular resistance was positively correlated with PF/VE,RR and Ti/Te(r=0.306,0.247,0.218,all P<0.05),and negatively correlated with MV,inspiratory time(Ti)and Te(r=-0.205,-0.207,-0.264,all P<0.05).Conclusion:Children with acyanotic congenital heart disease have obstructive ventilation dysfunction,which can occur restrictive ventilation dysfunction simultaneously with the increase of mean pulmonary artery pressure and pulmonary vascular resistance.