多普勒超声估测的肺动脉收缩压对心脏外科手术患者的预后价值──八年的回顾性分析

为了评价多普勒超声心动图所测量的肺动脉收缩压对确定心脏外科手术预后的价值，我们回顾性地研究了1987年到1994年8年间在我院心脏外科行手术治疗患者的术后住院死亡率。共有1607例心脏外科手术患者于我院心内科应用连续波多普勒技术无创地测量了肺动脉压力。这些患者的术前诊断主要是先天性心脏病和瓣膜性心脏病。按超声心动图估测的肺动脉收缩压将患者分为四组：无肺动脉高压＜30mmHg（第1组），轻度30～＜50mmHg（第2组），中度50～80mmHg（第3组），重度＞80mmHg（第4组）。以此标准，无肺动脉高压者920例（57．25％），肺动脉压力轻度升高者200例（12．45％），中度升高者243例（15．12％），重度升高者244例（15．18％）。术后死亡率分别为5．98％、4．00％、6．58％和13．52％（第4组死亡率明显高于前三组，P＜0．05）。结论：超声心动图无创测量的肺动脉收缩压，对先心病和瓣膜病的心外手术的近期预后判断有重要价值，重度肺动脉高压的心脏疾病患者的手术住院死亡率明显高于无肺动脉高压及轻中度肺动脉高压的患者。

Prognostic Value Of Doppler-Estimated Pulmonary Artery Systolic Pressures in Patients Undergoing Cardiac Surgery:An Eight Years' Retrospective Study

To assess whether Continuous-wave Doppler-determined pulmonary artery systolic pressure (PASP) has any prognostic value in patients undergoing cardiac surgery, we retrospectively analyzed the postoperative mortality in patients undergoing cardiac surgery from 1987 to 1994. A total of 1607 patients received preoperative CWD examinations and their PASPs were estimated noninvasively. The diagnoses in the majority of these patients were congenital and valvular heart diseases. Of these patients, 920 (57. 25%) cases were found to have no pulmonary artery hypertension (PH) with their PASPs being less than 30 mmHg (Goup 1), 200(12.45%) cases mild PH with their PASPs 30-50 mmHg (Group 2),243 (15.12%) cases moderate PH with their PASPs 50-80 mmHg (Group 3) and 244 (15. 18%) cases severe PH with their PASPs more than 80 mmHg (Group 4). The mortality rates in the four groups were 5. 98%, 4.0%, 6. 58% and 13. 52%, respectively.There was no significant difference of mortality among Group 1, Group 2 and Group 3. However,the mortality in Group 4 was significantly higher than that in any of the rest three groups (P<0. 05). It is concluded that PASP estimated by CWD is an important factor influencing the short-term prognosis of patients with congenital and valvular heart diseases after cardiac surgery, and in patients with severe PH the postoperative mortality is significantly higher than that in patients with no, forld and moderate PH.