肺血減少型復(fù)雜先天性心臟病姑息術(shù)后介入治療的臨床療效及對相關(guān)參數(shù)的影響

曾廣偉 尚福軍 康曉軍 牛曉琳 柳蔭 王翅遙 陳文生

肺血減少型復(fù)雜先天性心臟病姑息術(shù)后介入治療的臨床療效及對相關(guān)參數(shù)的影響

曾廣偉 尚福軍 康曉軍 牛曉琳 柳蔭 王翅遙 陳文生

目的 探討肺血減少型復(fù)雜先天性心臟病姑息術(shù)后介入治療的臨床療效及對跨肺動脈瓣壓力階差（PTG）、右室收縮壓（RVSP）、肺動脈收縮壓（PASP）、血氧飽和度（SaO2）的影響。 方法 選取 2010 年 1 月至 2016 年 1 月收治的肺血減少型復(fù)雜先天性心臟病姑息手術(shù)后介入治療的患兒 149 例，對其進行回顧性分析，分析其臨床效果與并發(fā)癥情況，術(shù)前及術(shù)后即刻右心導(dǎo)管及造影檢查 PTG、RVSP、PASP 及 SaO2變化情況；隨訪 12 個月，觀察肺動脈發(fā)育指標（Nakata 指數(shù)、McGoon 比值）、SaO2及 PTG改善情況。 結(jié)果 149 例患兒均順利進行經(jīng)皮球囊肺動脈擴張術(shù)，介入治療手術(shù)成功率為 100%，術(shù)后出現(xiàn)心律失常 3 例，2 例患兒出現(xiàn)發(fā)熱情況，并發(fā)癥總發(fā)生率為 3.36%；術(shù)后 PTG、RVSP、PASP 及 SaO2均比術(shù)前明顯改善（均 P＜0.01）；術(shù)后 1、3、6、12 個月患兒 Nakata、McGoon 及 SaO2呈上升趨勢，均比術(shù)前明顯改善，PTG 則明顯比術(shù)前下降（均 P＜0.01）。 結(jié)論 對肺血減少型復(fù)雜先天性心臟病外科姑息術(shù)后進行介入治療，有較好的臨床效果，并可降低術(shù)后并發(fā)癥，安全性高，并可有效促進肺血管發(fā)育及改善心室功能。

姑息術(shù)后 肺血減少型復(fù)雜先天性心臟病 經(jīng)皮肺動脈球囊擴張術(shù) 肺動脈狹窄

【 Abstract 】 Objective To evaluate the clinical efficacy of interventional therapy in pediatric patients with complex congenital heart disease of diminished pulmonary blood flow after palliative surgery. Methods One hundred and forty nine complex congenital heart disease pediatric patients with diminished pulmonary blood flow after palliative surgery were admitted in our hospital from January 2012 to June 2015.All patients received percutaneous balloon pulmonary artery dilatation,the pulmonary transvalvular gradient(PTG),right ventricle systolic pressure(RVSP),pulmonary arterial systolic pressure(PASP),and oxyhemoglobin saturation(SaO2)were measured by right cardiac catheterization before and after the intervention.Patients were followed up for 12 months,pulmonary artery development index(Nakata index,McGoon ratio),SaO2 and PTG were measured by the end of follow-up. Results The interventional procedures underwent smoothly in all 149 patients.There were 3 patients with arrhythmia and 2 patients with fever after operation with a perioperative complication rate of 3.36%.The PTG,RVSP,PASP and SaO2of patients were significantly improved after operation(P＜0.05);Nakata index,McGoon ratio and SaO2 of patients increased significantly at 1,3,6 and 12 months after operation;and PTG of patients was significantly decreased compared with preoperative value(P＜0.05). Conclusion Interventional therapy after palliative surgery can reduce postoperative complications, and promote pulmonary vascular development and improve ventricular function effectively for children with complex congenital heart disease of diminished pulmonary blood supply.

【 Key words 】 Palliative treatment Complex congenital heart disease patients with diminished pulmonary blood disease Percutaneous pulmonary artery balloon dilatation Pulmonary stenosis

肺血減少型先天性心臟病主要包括單心室、法洛四聯(lián)征、肺動脈閉鎖和伴有肺動脈狹窄等嚴重先天性心臟畸形[1]。傳統(tǒng)治療手段是進行外科手術(shù)，但由于患兒年齡小、肺動脈瓣或肺動脈畸形程度重，往往無法達到根治條件，因而常常進行體肺分流、雙向 Glenn 等姑息手術(shù)，以提高肺動脈供血，等待患兒逐步達到根治條件[2]。……