漂浮导管评估先心病合并重度肺动脉高压的价值.docVIP

  漂浮导管评估先心病合并重度肺动脉高压 的价值 邢建洲1，高尚志2，王志维2，林道明2，夏军2，李罗成2** 5 （1. 武警广东总队医院心血管外科，广州 510507； 2. 武汉大学人民医院心血管外科，武汉 430060） 摘要：目的 研究漂浮导管用于先天性心脏病合并重度肺动脉高压的意义及价值。方法 通 过右侧锁骨下静脉或颈内静脉插入漂浮导管，动态监测评估右心系统血流动力学，急性肺血 管反应试验，计算双向分流量，以此制定治疗方案。结果 漂浮导管检查双向分流的患者 10 15 20 25 30 35 40 85 例，漂浮导管保留时间 4~13 天（平均 7.5 天），平均肺动脉收缩压（mSPAP）/平均肱动 脉收缩压(mSBP)为 1.22±0.35，平均肺动脉平均压(mPAP)/ 平均肱动脉平均压(mBP)为 1.07 ±0.11，肺血管总阻力为 17.6±4.3 Wood 单位，急性肺血管反应试验阳性 67 例；艾森曼格 氏综合症为 14 例（14/85），采用内科保守治疗；接受外科治疗 71 例（71/85），术后动脉 血氧饱和度均较术前显著提高 9.2%±3.3%（p＜0.05）。结论 漂浮导管能准确反应右心系 统血流动力学，评估肺动脉高压的程度和性质，为临床对先天性心脏病合并重度肺动脉高压 治疗方案制定提供了可靠的、客观的理论依据。 关键词：先天性心脏病；肺动脉高压；右心导管检查；手术指针 中图分类号：R654 Floating catheter evaluates hemodynamics of congenital heart Xing Jianzhou1, Gao Shangzhi2, Wang Zhiwei2, Lin Daoming2, Xia jun2, Li Luocheng2 (1. Department of Cardiovascular Surgery, Guangdong Provincial Corps Hospital of Chinese Peoples Armed Police Force, Guangzhou 510507; 2. Dept. of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060) Abstract: Objective To monitor and evaluate hemodynamics of congenital heart disease(CHD) with severe pulmonary hypertension(PH) by means of floating catheter. Methords Through the right subclavian vein or jugular vein, floating catheter is inserted into pulmonary artery and monitor hemodynamics of right heart. Hemodynamics and acute pulmonary vasoreactivity testing are used to guide treatment of the patients with CHD. Results There were 85 cases with bidirectional shunt and severe PH. There were floating catheter retention of 4 to 13 days (average 7.5 days). Mean systolic pulmonary artery pressure(PAP) / mean systolic body artery blood pressure (BP) and mPAP / mBP were equal to 1.22 ± 0.35 and 1.07±0.11 respectively. The patients presented total pulmonary vascular resistance of 17.6±4.3 Wood units. Acute pulmonary vasoreactivity testing was positive in 67 cases. 14 cases with Eisenmengers syndrome underwent medical treatment. 71 cases underwent surgical treatment. With compared to preope