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|本期目录/Table of Contents|

成人先天性心脏病并发肺动脉高压外科治疗术后不良事件和右房改善的危险因素

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第6期
页码:
705-709
栏目:
临床研究
出版日期:
2017-06-01

文章信息/Info

Title:
Risk factor for adverse events and the improvement of right atrial size in patients with congenital heart disease associated with pulmonary arterial hypertension
作者:
胡 帅; 孙 怡; 苑振鹏; 魏以祯; 韩志岩; 王晓建; 李巅远
（中国医学科学院、北京协和医学院阜外医院心外科，北京 100037）
Author(s):
HU Shuai;  SUN Yi;  YUAN Zhen-peng;  WEI Yi-zhen;  HAN Zhi-yan;  WANG Xiao-jian;  LI Dian-yuan
(Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
关键词:
心脏病; 先天性; 肺动脉高压; 外科治疗; 危险因素
Keywords:
congenital heart defect;  pulmonary arterial hypertension;  surgical treatment;  risk factors
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
目的 分析先天性心脏病（CHD）并发肺动脉高压（PAH）（CHD-PAH）患者手术后不良事件、右房大小改善的危险因素。方法 收治79例CHD-PAH患者。初诊，右心导管检查和吸氧实验，确诊PAH、肺血管反应性，其中13例患者肺血管阻力（PVR）<10 Wood单位、体循环血流量（Qp）与肺循环血流量（Qs）的比值(Qp/Qs)≥1.5、血氧饱和度(SaO2)≥95%，且心功能较好者直接行手术治疗，其余66例患者接受靶向药物治疗3个月后，复查右心导管进行评估手术。结果 术后不良事件发生17例，其中肺高压危象11例，撤机困难需气管切开4例以及低心排综合征2例。53例患者术后右房恢复正常大小。有无不良事件组间比较结果显示：术前PVR≥10 Wood单位、Qp/Qs、SaO2、肺动脉收缩压/主动脉收缩压（SPAP/SBP）>0.75、SPAP、肺动脉舒张压（DPAP）是术后不良事件的影响因素（均P<0.01），多因素Logistic回归分析结果显示SaO2（OR=0.584,P=0.015）越高，不良事件发生率越低；术后右房大小改善是否满意组间单因素分析显示：PVR≥10 Wood单位、右房压（RAP）>8 mmHg(1 mmHg=0.133 kPa)、血流分流方向是其影响因素（均P<0.05），多因素Logistic回归分析结果显示其危险因素是RAP>8 mmHg（OR=3.398,P=0.029）。结论 CHD-PAH患者术后不良事件的危险因素是SaO2的降低,影响右房改善的危险因素是RAP>8 mmHg。
Abstract:
AIM To analyze the risk factors of adverse events and the improvement of right atrial size before and after surgery in patients with congenital heart disease with pulmonary arterial hypertension (CHD-PAH). METHODS From June 2014 to June 2016, 79 patients with CHD-PAH underwent surgical repair. There were 25 males and 54 females, 18 to 61 years old. Newly diagnosed, to having a diagnosis PAH and oxygen reactive pulmonary vasculature by right heart catheterization, 13 patients with pulmonary vascular resistance (PVR)<10 Wood units, Qp/Qs≥1.5, SaO2≥95% underwent direct surgical repair, who have better cardiac function. The remaining 66 patients received targeted therapy three months，then had an additional right heart catheterization. RESULTS The early postoperative adverse events included pulmonary crisis in 11 patients, tracheotomy with difficulty in extubation in 4 patients, low cardiac output syndrome occured in 2 patients; and there were 53 patients with postoperative right atrium returned to normal size. The preoperative PVR≥10 Wood units, Qp/Qs, SaO2, systolic pulmonary arterial pressure/systolic blood pressure (SPAP/SBP)>0.75, SPAP, DPAP (P<0.01) were influencing factors in the early postoperative adverse events. Univariate analysis revealed that the higher the SaO2 (OR=0.584, P=0.015), the lower the incidence of adverse events. Preoperative PVR≥10 Wood units, right atrial pressure (RAP)>8 mmHg, shunting direction (P<0.05) were the significantly impacted right atrial enlargement. Univariate analysis revealed RAP>8 mmHg (OR=3.398, P=0.029) was the independent risk factors of right atrial improvement. CONCLUSION The risk factor for postoperative adverse events in CHD-PAH patients was reduction of SaO2, and risk factor for right atrial improvement was RAP>8 mmHg.

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备注/Memo

备注/Memo:
收稿日期：2017-03-16.
通讯作者：李巅远，主任医师，主要从事心血管外科疾病研究 Email：dianyuanli@yahoo.com
作者简介：胡帅，硕士生 Email:hus.huai@163.com
更新日期/Last Update: 2017-06-06