摘要
目的探讨先天性心脏病（简称先心病）合并重度肺动脉高压患儿器质性肺动脉高压（简称肺高压）的诊断标准。方法３７例经手术治疗后早期肺动脉压力降至正常的患儿作为动力性肺高压组；７例经手术治疗后仍持续性肺动脉高压及６例临床诊断为器质性肺高压而未予手术的共１３例患儿作为器质性肺高压组，对比两组心导管检查血液动力学指标。结果两组肺血管阻力、肺小动脉楔压、肺循环血流量与体循环血流量之比（Ｑｐ／Ｑｓ）及降主动脉血氧饱和度（ＳａＯ２）差异均有显著意义，如按年龄大于２岁、肺动脉阻力＞７２ｋＰａ·ｓ－１·Ｌ－１（９Ｗｏｏｄ单位）、肺小动脉楔压≤１．６ｋＰａ（１２ｍｍＨｇ）、Ｑｐ／Ｑｓ＜２和动脉血氧饱和度＜０．９０作为临床诊断器质性肺高压的指标，则本组动力性肺高压组仅有５．４％的患儿符合上述指标３项或３项以上，而器质性肺高压组所有病例均符合上述指标３项或３项以上。结论先心病合并重度肺动脉高压存在上述５项指标中３项或３项以上。
Objective To determine the diagnostic standard for organic pulmonary hypertension (PH). Methods The patients with congenital heart defects and severe PH were divided into two groups. Dynamic PH group consisted of 37 cases who accepted surgical repair for their cardiac defects and PH was reversed dramatically after operation. Organic PH group consisted of 13 cases, seven of them accepted surgical repair while their pulmonary artery pressure sustained a higher level postoperatively. Another 6 were not operated on because of the obvious right to left shunt. Results Significant differences were found in pulmonary resistance, pulmonary wedge pressure, Qp/Qs and arterial oxygen saturation between the 2 groups. If such 5 parameters as being older than 2 years of age, below 1.6 kPa for pulmonary wedge pressure, over 72 kPa·s -1 ·L -1 for pulmonary resistance, less than 2 for Qp/Qs ratio and lower than 0.90 for arterial blood saturation were used to evaluate the organic PH clinically, 3 or more above parameters exsisted in 2 of 37 cases in dynamic PH group and in all 13 cases in organic PH group. Conclusion If a patient with congenital heart defects and severe PH had 3 or more of above 5 paremeters, organic or irreversible PH should be suspected and further pulmonary wedge angiogram, pulmonary vasodilative test or lung biopsy be suggested to decide the operative indication.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
1998年第2期104-106,共3页
Chinese Journal of Pediatrics
