摘要
目的探索能更准确反映肺血管发育及肺血流情况的指标,为外科手术方案的选择提供依据。方法采用74例肺血减少型先天性心脏病心血管造影序列,测量左右肺动脉及4根肺静脉直径,分别计算 Nakata 指数,McGoon 指数,肺静脉指数(PVI),分别与术后情况进行相关分析。结果左、右侧肺静脉大小分别与左右肺动脉大小高度相关,左侧肺静脉与左肺动脉远端的相关性为0.73,左侧肺静脉与左肺动脉近端的相关性为0.72,右侧肺静脉与右肺动脉远端的相关性为0.67,右侧肺静脉与右肺动脉近端的相关性为0.71。PVI 与术后监护时间,呼吸机维持时间,正性肌力药物用量的相关性分别为-0.51,-0.478和-0.693,均比 Nakata 指数,McGoon 指数明显增高,能更准确的反映整个肺血管的发育情况。右室流出道重建术后无低心排组与低心排组的 McGoon 指数分别为1.97±0.58与1.36±0.51(t=2.347,P<0.05),两组 Nakata 指数分别为(269±124)mm^2/m^2和(164±106)mm^2/m^2(t=2.218,P<0.05),PVI 分别为(273±125)mm^2/m^2和(152±77)mm^2/m^2(t=2.936,P<0.01),低心排组肺血管值均明显小于无低心排组。当 PVI 小于180 mm^2/m^2时,术后易出现血流动力学不稳定,低心排,甚至死亡。结论肺动脉、肺静脉发育彼此相关,PVI 能更准确反映肺血管发育及肺血流情况的形态学指标,为外科手术方案的选择提供有效依据。
Objective The development status of pulmonary artery is one of the most important criteria for decision-making strategy and predicting postoperative outcome in congenital heart disease with decreased pulmonary blood flow. Currently, Nakata index and McGoon index have been used as morphologic index in evaluating the development status of pulmonary artery, Those indices have some shortcoming. It was recently found that pulmonary veins index is a more precise morphological indicator of pulmonary blood flow and development status of pulmonary vessels, This study aimed to explore an index of evaluating pulmonary blood stream and the development of pulmonary vessels, as a criterion for surgical decision-making strategy. Methods The diameters of left and right pulmonary arteries and pulmonary veins were measured on DSA films in 74 patients with congenital heart disease with decreased pulmonary blood flow, The correlative analysis was done between Nakata index, McGoon index, pulmonary vein index （PVI） and postoperative outcome which were the length of stay in ICU, duration of mechanical ventilation and dose of inotropic drugs. Results Excellent correlations between the size of pulmonary veins and pulmonary arteries were found, the correlation between left pulmonary veins and distal portion of left pulmonary artery was 0. 73, between left pulmonary veins and proximal portion of left pulmonary artery was 0. 72, right pulmonary veins and distal portion of right pulmonary artery was 0. 67, and right pulmonary veins and proximal portion of right pulmonary artery was 0. 71. The length of stay in ICU, duration of mechanical ventilation and dose of inotropic drugs correlated well with PVI （ r = - 0. 51, - 0. 478, and - 0. 693 ）. Compared with Nakata index and McGoon index, PVI was a better criterion for evaluating the developmental status of the whole pulmonary vessels. In the right ventricular outlet reconstruction patients, the McGoon index for patients with low cardiac output syndrome （LCOS） was 1.36 20. 51, and 1
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2007年第12期889-892,共4页
Chinese Journal of Pediatrics
关键词
肺静脉
肺动脉
心脏缺损
先天性
Pulmonary veins
Pulmonary artery
Heart defects, congenital
