动脉导管未闭封堵术后即刻血压变化研究

目的：探查动脉导管未闭介入封堵手术后血压的急性变化规律。方法连续收录2009年10月-2012年12月间于大连医科大学附属第一医院住院拟行动脉导管未闭介入封堵手术的住院患者54例，根据年龄将患者分为儿童组（≤16岁，29例）和成人组（＞16岁，25例），在介入手术过程中通过股动脉鞘管监测实时血压，通过右心导管测量肺动脉压力。分析比较不同年龄组血压的变化规律及其可能的相关因素。结果（1）均成功行经皮穿刺动脉导管未闭封堵术。24例合并不同程度的肺动脉高压，肺动脉平均压14～58 mmHg。主动脉造影显示动脉导管：41例呈漏斗型，11例呈管型，2例呈不规则型，最窄处内径1.9～9.7 mm。（2）成人组基线和术后即刻股动脉压力水平及升高的幅度显著高于儿童组（P＜0.01），平均血压增高18.5％（儿童组13.6％，成人组23.0％，P＝0.001）。（3）术后即刻血压水平与年龄、基线血压水平密切相关（r＝0.881和0.867，P＜0.01）。结论动脉导管未闭介入封堵术后即刻所有患者血压均增高，增高幅度与年龄及基线血压水平密切相关。

Acute changes in blood pressure after interventional occlusion of patent ductus arteriosus

Objective To observe acute changes in blood pressure after interventional occlusion of PDA .Methods 54 inpatients , who intended to perform interventional occlusion of PDA in the first affiliated hospital of Dalian Medical University, were continuously recruited from October 2009 to December 2012.Detailed history was recorded.Routine physical and laboratory tests were performed.Subjects were divided into children group （≤16year, 29 cases） and adult group （ 〉16year, 25 cases） according to the age.Active femoral blood pressure was measured via femoral short sheath during the interventional procedure , and pulmonary pressures were measured by right heart catheterization .Blood pressure change and the possible related factors were analyzed .Statistical analysis was performed using SPSS17.0 software package.Results 1） All of the patients received interventional PDA occlusion successfully .24 subjects had pulmonary hypertension , with mean pulmonary artery hypertension 14-58 mmHg.The shapes of PDA were funnel shape （41 cases）,tubular shape （11 cases） and irregular shape （2 cases）.Diameters were 1.9-9.7 mm.2） The basic and post intervention pressures of femoral artery in Adult group were significantly higher than those in Children group （P〈0.01）.The mean blood pressure increased 18.5%（13.6%in children and 23.0%in adults） with significant difference （P=0.001）.3）The blood pressure imme-diately after intervention were significantly related to age and basic blood pressure （r=0.881 and 0.867,P〈0.01）.Con-clusion The blood pressure of all subjects increased after PDA occlusion and the amplitude was closely related to age and basal blood pressure level .