6分钟步行距离试验评估合并肺动脉高压的先天性心脏病患者手术效果

目的:探讨6min步行距离试验(6-minute walk test,6MWT)评估合并肺动脉高压的先天性心脏病(先心病)患者手术效果的临床价值。方法:选取2007年3月至2010年2月在我科住院的58例先心病合并肺动脉高压患者。其中男性30例,女性28例;平均年龄(34.5±10.2)岁。心脏超声测量肺动脉收缩压(systolic pulmonary artery pressure,sPAP)。将58例患者按sPAP分为3组,A组20例患者,30mmHgsPAP50mmHg(1mmHg=0.133kPa),B组20例患者,50mmHg≤sPAP70mmHg,C组18例患者,sPAP≥70mmHg。所有患者经手术完全矫治心脏畸形。手术前后测量sPAP及6MWT。术后记录机械通气时间、ICU停留时间。结果:全组手术无死亡。手术前A、B及C组的sPAP分别为(33.3±7.1)mmHg、(58.6±12.1)mmHg及(73.6±12.5)mmHg;手术后3组的sPAP分别为(25.5±5.8)mmHg、(38.8±12.5)mmHg及(64.8±11.5)mmHg;与手术前相比3组sPAP均明显下降,P0.05。手术前A、B及C组的6MWT分别为(420.2±33.3)m、(354.2±48.3)m及(320.2±41.3)m;手术后3组的6MWT分别为(440.8±22.5)m、(400.8±35.7)m及(340.2±38.2)m;与术前相比3组均明显提高,P0.05,B组手术后6MWT提高最明显,P0.01。A、B及C组术后机械通气时间分别为(4.2±2.3)h、(8.6±4.3)h及(14.2±6.6)h;术后ICU停留时间分别为(1.0±0.4)d,(2.1±1.1)d及(5.3±2.1)d。组间比较C组的机械通气时间、ICU停留时间明显较A、B组为长。结论:心脏手术前后重复6MWT能够评价合并肺动脉高压的先心病患者运动能力改善情况,评估手术效果。

Clinical application of 6-minute walk test to evaluate the surgical effect of congenital heart disease with pulmonary hypertension

Objective：To estimate the clinical application of 6-minute walk test（6 MWT） to surgical effect of congenital heart disease with pulmonary hypertension.Methods：From March 2007 to February 2010,58 patients with pulmonary hypertension induced by congenital heart disease were enrolled.There were 30 males and 28 females,the mean age was（34.5 ± 10.2） years.The patients were divided into three groups according to the systolic pulmonary artery pressure（sPAP）.The sPAP between 31 mmHg and 49 mmHg was in group A,50 mmHg to 70 mmHg in group B,and above 70 mmHg in group C.All patients received complete surgical correction.The sPAP and results of 6 MWT were recorded perioperatively.The length of mechanical ventilation and stay in ICU after operation was also recorded.Results：No surgical death occurred.The sPAP was decreased from（33.3 ± 7.1） mmHg to（25.5 ± 5.8） mmHg in group A,decreased from（58.6 ± 12.1） mmHg to（38.8 = 12.5）mmHg in group B and decreased from（73.6 ± 12.5） mmHg to（64.8 ± 11.5）mmHg in group C（all P 0.05）.The 6 MWT was raised from（420.2 ± 33.3）meters to（440.8 ± 22.5）meters in group A,raised from（354.2 ± 48.3）meters to（400.8 ± 35.7）meters in group B and raised from（320.2 ± 41.3）meters to（340.2 ± 38.2）meters in group C（all P 0.05）.The length of mechanical ventilation was（4.2 ±2.3）h in group A,（8.6 ±4.3）h in group B and（14.2 ±6.6）h in group C.The stay in ICU was（1.0 ± 0.4）d in group A and（2.1 ± 1.1） h in group B and（5.3 ± 2.1） h in group C.Conclusion：Repeated 6 MWT perioperatively can evaluate the effect of surgery and the recovery in patients with pulmonary hypertension induced by congenital heart disease.