左向右分流先天性心脏病对儿童肺功能的影响

目的探讨左向右分流先天性心脏病(congenital heart disease,CHD)对儿童肺功能的影响。方法前瞻性入组2019年5月~2020年1月确诊为左向右分流先天性心脏病并完成肺功能检查的患儿,研究期间共入组69例研究对象。无法配合完成用力肺活量检查者(0~3.5岁,婴幼儿组),采用潮气呼吸法检查肺功能,能配合完成用力肺活量检查者(3.5~13岁,年长儿组),采用用力肺活量法完成肺功能检查。根据先天性心脏病类型及缺损口直径大小分为小分流量组(缺损口直径<8 mm的小型ASD、缺损口直径<5 mm的小型VSD)及大分流量组(缺损口直径≥8 mm的中大型ASD、缺损口直径≥5 mm的中大型VSD及PDA)。入选年龄、性别相匹配的正常儿童50例为对照组,比较小分流量组、大分流量组与婴幼儿对照组之间以及左向右分流先天性心脏病年长儿组与年长儿对照组间的肺功能差异。结果婴幼儿组CHD患儿FRCp/kg显著高于对照组,差异有统计学意义(P<0.05),其中大分流量组CHD患儿RR显著高于小分流量组及对照组(P<0.05),PTEF/TEF₂₅显著高于对照组(P<0.05),而TPTEF/TE、VPTEF/VE、Ti/Te显著低于对照组(P<0.01)。婴幼儿组CHD患儿与对照组VT、TEF₅₀/TIF₅₀、PEF、TEF₇₅、TEF₅₀、TEF₂₅、Reff差异无统计学意义。年长儿组CHD患儿FEV_0.5、FEV₁/FVC、PEF、MEF₇₅、MEF₅₀、MEF₂₅、MMEF显著低于对照组,差异有统计学意义(P<0.05)。结论左向右分流CHD儿童均存在呼吸道阻塞,在婴幼儿CHD患儿中,分流量显著者常为阻塞性通气功能障碍,且主要为小气道阻塞。左向右分流CHD年长儿均有阻塞性通气功能障碍,且其从小气道到大气道均有不同程度的阻塞。

The effect of the left-to-right shunt congenital heart disease on children's pulmonary function

Objective To explore the effect of the left-to-right shunt congenital heart disease on children's pulmonary function.Methods During the study,69 children diagnosed as the left-to-right shunt congenital heart disease and having accomplished pulmonary function test in our hospital from May 2019 to January 2020 were enrolled prospectively as study objects.Children who could not accomplish the forced vital capacity test(0~3.5 years old,infants group)were tested pulmonary function with tidal breathing method.Children who could accomplish the forced vital capacity test(3.5~13 years old,older children group)were tested pulmonary function with forced vital capacity method.The children were divided into small shunt group(small ASD with the diameter of defect mouth less than 8 mm and small VSD with the diameter of defect mouth less than 5 mm)and large shunt group(medium and large ASD with the diameter of defect mouth not less than 8 mm,medium and large VSD with the diameter of defect mouth not less than 5 mm and PDA),according to the type of congenital heart disease and the diameter of defect mouth.50 normal children with matching age and sex were selected as control group.Compare the difference of pulmonary function among the small shunt group,the large shunt group and the infants control group,and the difference of pulmonary function between the older children group with the left-to-right shunt congenital heart disease and the older children control group.Results The value of FRCp/kg for children with CHD in infants group was significantly higher than that in control group and the difference was statistically significant(P<0.05),and the value of RR for children with CHD in large shunt group was significantly higher than that in small shunt group and control group(P<0.05),the value of PTEF/TEF₂₅ was significantly higher than that in control group(P<0.05),while the values of TPTEF/TE,VPTEF/VE,Ti/Te were significantly lower than that in control group(P<0.01).There was no statistical difference in the values of VT,TEF₅₀/TIF₅₀,PEF,TEF₇₅,TEF₅₀,TEF₂₅ and Reff between the children with CHD in infants group and control group.The values of FEV_0.5,FEV₁/FVC,PEF,MEF₇₅,MEF₅₀,MEF₂₅ and MMEF for the children with CHD in older children group were significantly lower than those in the control group and the difference was statistically significant(P<0.05).Conclusion There was airway obstruction in all children with the left-to-right shunt CHD.In infants with CHD,those with significant shunt volume were often with obstructive ventilation dysfunction,and mainly with small airway obstruction.There was obstructive ventilation dysfunction in all older children with left-to-right shunt CHD,different in degree of obstruction from small airway to large airway.