室间隔缺损合并肺动脉高压肺血管床功能状态评估指标的研究

目的探讨室间隔缺损合并肺动脉高压肺血管床功能状态的评估指标。方法对室间隔缺损合并重度肺动脉高压的患儿，于心导管术中应用酚妥拉明，将轻度全肺循环阻力（ＴＰＲ）增加的２７例与重度全肺循环阻力增加的１２例患儿的试验结果进行比较。结果两组患儿的单一肺动脉压降幅（Ｐｐ降幅）分别为２．３ｋＰａ（１７ｍｍＨｇ，１ｋＰａ＝７．５ｍｍＨｇ）和２．２ｋＰａ，Ｐ＞０．０５，差异无显著意义；而肺动脉压降幅（Ｐｐ降幅）／体循环压降幅（Ｐｓ降幅）的比值，试验前后肺动脉血氧饱和度变化值这二项指标的差异有非常显著意义（Ｐ＜０．０１）。Ｐｐ降幅／Ｐｓ降幅比值与全肺循环阻力的相关性良好［ｒ＝－０．８９９），Ｙ（ＴＰＲ）＝２６６８－１８９２Ｘ（Ｐｐ降幅／Ｐｓ降幅）］。结论用酚妥拉明作扩血管降压试验时，单一的肺动脉压降幅不能完全反映肺血管床的功能状态；而Ｐｐ降幅／Ｐｓ降幅比值，试验前后肺动脉血氧饱和度变化值这二项指标对室间隔缺损合并肺动脉高压患儿的肺血管床功能状态的评估，对手术适应证的选择具有一定指导意义。

The new indices in assessing functional status of pulmonary vascular bed in children with pulmonary hypertension due to ventricular septal defects

Objective To evaluate the indices in assessing functional status of pulmonary vascolar bed in children with pulmonary hypertension (PH) due to ventricular septal defects (VSD). Methods Phentolamine tests were performed in 39 children with severe PH due to VSDs during cardiac catheterization. Results The declining amplitude of pulmonary artery pressure after phentolamine infusion was 2.3 kPa (17 mmHg, 1 kPa= 7.5 mmHg) in 27 children with a slightly increased total pulmonary resistance (TPR), and was 2.16 kPa in 12 children with a severely increased TPR. The difference did not reach a significant level ( P >0.05). Two new indices, the ratio of declining amplitude of pulmonary artery pressure to declining amplitude of systemic pressure (Ps) and the change in oxygen saturation in the pulmonary artery were significantly different between the two groups (both P < 0.01). The ratio of declining amplitude of pulmonary artery pressure to that of Ps showed a strong correlation with TPR ( r =-0.899).Conclusion It is suggested that the new indices, the ratio of declining amplitude of pulmonary artery pressure to that of Ps, and the change in oxygen saturation in the pulmonary artery may be of implication in evaluating the functional status of pulmonary vascular bed in children with PH due to VSDs.