影响儿童继发孔型房间隔缺损肺动脉压力的因素

目的 探讨儿童继发孔型房间隔缺损（ASD）肺动脉压力的影响因素.方法 回顾性分析2000年4月至2011年1月沈阳军区总医院收治的10岁以下继发孔型ASD患者,全部患儿在氯胺酮全麻下行心导管检查测肺动脉压力,并完成封堵治疗.收集患者性别、年龄、身高、体重及体表面积、ASD直径、心胸比值和肺动脉收缩压、舒张压、平均压,术后超声心动图随访1年,并按缺损直径和年龄分组.结果 本研究共359例患儿,男130例（36.2％）.平均年龄（5.8±2.2）岁（2～10岁）,平均体重（21.0±7.1） kg （10～57kg）,平均缺损直径（13.6±5.6） mm（5～30 mm）,体表面积矫正缺损直径为（17.0±7.1） mm/m2（1.3～41.0 mm/m2）,平均肺动脉收缩压（40.8±8.7 mmHg） （15～67 mmHg）（1 mmHg=0.133 kPa）.318例（88.6％）患者心导管测量存在肺动脉高压,所有患者术前及术后1、3、6、12个月超声估测肺动脉压均正常;肺动脉压力不随房间隔缺损直径增大而升高（P＞0.05）;10岁以下儿童肺动脉压力与年龄和体表面积矫正的缺损直径无相关性（P＞0.05）.结论 10岁以下继发孔型ASD患儿,心导管检查所测肺动脉压力与患儿年龄和体表面积矫正的缺损直径无关,与缺损直径无简单线性关系,压力不随缺损直径增大而升高.

Risk factors of pulmonary arterial hyperpressure in children with secundum atrial septal defect

Objective To discover the risk factors of pulmonary arterial hyperpressure（PAH） in children with secundum atrial septal defect（ASD）.Methods Patients whose ages were less than 10 years old were admitted and underwent percutaneous occlusion of ASD with occluder in general anesthesia with ketamine in General Hospital of Shenyang Military Command from April,2000 to January,2011.All patints were followed up for 1 year with echocardiography.The patients were divided into different groups according to size of the ASD and ages.Results 1.359 patients were concluded,male was 130 cases （36.2 per cent）,mean ages were 5.8 ±2.2years old （range from 2 to 10 years）,mean weights were 21.0±7.1 kilograms （range from 10.0 to 57.0 kg）,mean highs were 115.1±15.1 cm （range from 77 to 160 cm）,mean body surface areas （BSA） were 0.82±0.18 m2 （range from 0.46 to 1.53 m2）,mean sizes of ASD were 13.6±5.6 mm （range from 5 to 30 mm）,mean sizes of ASD modified by BSA were 17.0±±7.1 mmn/m2 （range from 1.3 to 41.0 mm/m2）.Mean systolic PAPs were 40.8±8.7 mmHg （range from 15 to 67 mmHg）,mean diastolic PAPs were 16.5±6.3 mmHg （range from 3 to 45 mmHg）,mean PAPs were 24.6±±6.3 mmHg （range from 12 to 48 mmHg）.318 patients （88.6％） had pulmonary arterial hypertension measured by right heart catheterization （RHC）,but no patient had PAH at prior to procedure and 1,3,6,12 months post procedure by echocardiography.2.Pulmonary artery pressure does not increase with atrial septal defect diameter increase （P ＞ 0.05）.3.Pulmonary artery pressure has no correlation with age and ASD defect corrected by BSA in children under 10 years of age （P ＞ 0.05）.Conclusions Children under 10 years old with atrial septal defects,pulmonary artery pressure measured by heart catheterization has no correlation with the age and ASD defect corrected by BSA.There have no simple linear relationship between pulmonary arterial pressure and the defect diameter,the pulmonary arterial pressure does not inc