摘要
目的观察先天性心脏病术前肺血管阻力(Rp)、肺动脉/体循环压(Pp/Ps)、肺循环/体循环血流(Qp/Qs)比值与术中肺/体循环压力比值(Rp/Ps)间的关系,评估Rp对术中肺动脉高压危象的预测作用,及其对术中应用一氧化氮(NO)的指征作用。方法本组患儿共46例,术前心导管检查证实均为先天性心脏病伴肺动脉高压,并拟行心脏直视手术。术前用药及麻醉方法基本相同。术前Rp、Pp/Ps、Qp/Qs值在心导管检查时由Fick公式计算。体外循环(CPB)结束前分别在肺动脉及升主动脉直接测定肺动脉压(Pp)和体循环压(Ps),计算出术中Pp/Ps,并将其与术前Rp、Pp/Ps、Qp/Qs值分别进行相关分析。结果术前Rp值与CPB脱机时的Pp/Ps比值呈正相关(r2=0.86,P<0.05,n=46),而术前Pp/Ps比值和Qp/Qs比值则与CPB脱机时的Pp/Ps比值无明显关系。术前Rp<7.0Woodunitm2的病例术中均未发生肺动脉高压危象。发生肺动脉高压危象的4例中,术前Rp值平均为(12±2.6)Woodunitm2(7.4～15)。结论术前Rp可有效的预测CPB后肺动脉高压危象的发生,并可作为术中使用NO吸入治疗的指征。
Objective To investigate the relationship among pulmonary vascular resistance(Rp),Pp/Ps ratio,Qp/Qs ratio and Rp/Ps ratio. Methods 46 infants with pulmonary hypertension(PH) were studied.Preoperative Rp,Pp/Ps,and Qp/Qs levels were calculated during cardiac catheterization by the Fick's Method.Main pulmonary arterial pressure(Pp) and ascending aortic pressure(Ps) were measured at the time of weaning from CPB,and Pp/Ps ratio were calculated from mean values of these pressure measurements.The relationships among preoperative Rp,Pp/Ps,Qp/Qs values and Pp/Ps ratio at the time of weaning from cardiopulmonary bypass(CPB) were respectively observed. Results Preoperative Rp value correlated positively with Pp/Ps ratio at the time of weaning form CPB(r 2= 0.76 ,P<0.05,n=46).No relationships were demonstrated between preoperative Pp/Ps ratio and the Pp/Ps at the time of CPB weaning, and between preoperative Qp/Qs and Pp/Ps at the time of CPB weaning.PH crisis was not observed in the cases with preoperative Rp values under 7 Wood unit m 2.PH crisis occurred only in 4 cases in whom the preoperative Rp value was (12±2.6) Wood unit m 2( 7.4 ～15). Conclusion Preoperative Rp can be used reliably to predict PH crisis after weaning from CPB and to guide treatment with NO inhalation.
出处
《中国心血管病研究》
CAS
2004年第8期599-601,共3页
Chinese Journal of Cardiovascular Research
关键词
心脏疾病
先天性
肺血管阻力
肺动脉高压危象
NO吸入
胸外科手术
heart disease,congenital
pulmonary vascular resistance
pulmonary hypertension crisis
NO inhalation
cardiac surgery
