肺体循环血量比在动脉导管未闭合并重度肺动脉高压患者介入术中的应用研究

The study on the application of pulmonary systemic blood volume ratio in transcatheter closure of patent ductus arteriosus patients with severe pulmonary hypertension

摘要:

目的 对比分析行介入治疗的动脉导管未闭（patent ductus arteriosus，PDA）合并重度肺动脉高压（pulmonary artery hypertension，PAH）患者术前及术后血流动力学及心脏超声指标，探讨该类患者中肺体循环血量比（pulmonary to systemic flow ratio，Qp/Qs）与介入术后肺动脉压力改变、心脏结构恢复的相关性及预测价值。方法 选取行介入封堵术的PDA合并PAH患者33例，根据术前Qp/Qs分为Qp/Qs≥2.5组（A组）及Qp/Qs<2.5组（B组），采集术前术后2组心导管检查获得的血流动力学参数，并记录术前术后随访的经胸超声心动图（transthoracic echocardiography，TTE）结果，对2组进行组内及组间对比分析。结果 ①术前2组间肺动脉收缩压（systolic pressure of pulmonary artery，sPAP）及肺动脉平均压（mean pressure of pulmonary artery，mPAP）无差异，术后即刻A组的sPAP及mPAP均低于B组。②A组的左心室舒张末期内径指数（left ventricular end diastolic diameter index，LVEDDI）、左心房内径指数（left atrial diameter index，LAI）、肺动脉内径指数（pulmonary artery diameter index，PAI）在术后48 h、术后1个月、术后3个月均较术前降低，B组仅PAI、LVEDDI在术后3个月较术前降低；术前2组间右心室舒张末期内径指数（right ventricular end diastolic diameter index，RVEDDI）无差异，术后3个月A组低于B组。③5例术后即刻残留重度PAH患者均发生于B组。其中1例患者靶向药物治疗效果显著。结论 ①对于合并重度PAH的PDA患者，Qp/Qs比值越大，术后肺动脉压力、心脏结构恢复越明显。②Qp/Qs对该类患者术后即刻残留重度PAH有一定预测价值。

Abstract:

Objective To compare and analyze the hemodynamics and cardiac ultrasound indexes before and after operation in patients with patent ductus arteriosus（PDA） complicated with severe pulmonary artery hypertension（PAH） who have undergone interventional treatment，so as to explore the correlation of pulmonary to systemic flow ratio（Qp/Qs） with pulmonary artery pressure change and cardiac structure recovery and predictive value of Qp/Qs after interventional treatment of such patients.Methods A total of 33 PDA patients complicated with PAH who had undergone interventional occlusion were divided into group A（Qp/Qs≥2.5） and group B（Qp/Qs<2.5） according to the preoperative Qp/Qs. The hemodynamic parameters obtained by cardiac catheterization before and after the operation were collected， and the results of transthoracic echocardiography（TTE） before and after the operation were recorded. The two groups were compared and analyzed.Results ①There was no difference in systolic pressure of pulmonary artery（sPAP） and mean pressure of pulmonary artery（mPAP） between the two groups before operation. Immediately after operation，the sPAP and mPAP in group A were lower than those in group B. ②The left ventricular end diastolic diameter index（LVEDDI），left atrial diameter index（LAI） and pulmonary artery diameter index（PAI） in group A were lower than those before operation at 48 hours，1 month and 3 months after operation，while only PAI and LVEDDI in group B were lower than those before operation at 3 months after operation. There was no difference in right ventricular end diastolic diameter index（RVEDDI） between the two groups before operation， and group A was lower than group B 3 months after operation. ③Five patients with immediate residual severe PAH occurred in group B. Among them，targeted drug therapy was significantly effective in 1 patient.Conclusion ①For PDA patients with severe PAH，the greater the Qp/Qs ratio，the more obvious the recovery of pulmonary artery pressure and cardiac structure after operation. ②Qp/Qs has a certain predictive value for the immediate residual severe PAH in these patients.