风湿性心脏病二尖瓣狭窄合并肺动脉高压者rn血管力学特性的变化

摘要

目的　探讨风湿性心脏病(风心病)二尖瓣病变合并肺动脉高压(肺高压)的肺血管力学特性的变化规律。方法　借助右心导管技术和利用压力波形面积确定动脉顺应性的改进方法，测定肺血流动力学和肺血管顺应性。结果　①二尖瓣狭窄(MS)为主合并肺高压组的肺动脉血管零压(C0)较正常对照组明显下降［(9.98±2.23) ml/mm Hg对(2.40±0.68)ml/mm Hg，P＜0.01］，风心病合并严重肺动脉高压(mPAP≥35.00 mm Hg)比轻度肺动脉高压(mPAP＜35.00 mm Hg)下降更为明显［(2.78±0.83) ml/mm Hg对(2.04±0.55)ml/mm Hg，P＜0.05］；②MS组术前mPAP与反映血管壁固有结构的C0之间呈显著负相关(r=－0.745，P＜0.05)；③分别比较手术后应用硝普钠(0.5μg.kg-1.min-1)观察轻度肺高压组和MS重度肺高压组的肺循环血流动力学和血管顺应性的变化，两组病人用药后PAP、肺血管阻力(PVR)均显著下降(P＜0.01)，轻度肺高压组C0和肺动脉平均压(Cm)均明显升高(P＜0.01)；而MS组重度肺高压组C0用药前后无明显变化［(2.35±1.24) ml/mm Hg对(2.24±1.53) ml/mm Hg，P＞0.05)，Cm由于肺动脉压下降而呈显著升高［(1.51±0.59)ml/mm Hg对(1.81±0.77) ml/mm Hg，P＜0.05］。结论　风心病肺高压肺血管都存在不同程度的重建，二尖瓣狭窄合并肺高压肺血管结构重建严重程度是影响术前肺动脉压水平的主要因素，合并有重度肺高压的病人对扩血管药物反应明显低下，可能与血管壁胶原组织积聚、平滑肌细胞舒缩功能下降或萎缩有关。%Objective: To evaluate the mechanical properties of pulmonary artery in patient with rheumatic valvular disease. Method: This study consisted of 27 patients with rheumatic valve disease comparing with 8 normal controls. Pulmonary pressure curves were obtained by right heart catheterization. Pulmonary arterial resistance and compliance were calculated.Results: (1)As compared to the controls, the pulmonary arterial compliance in mitral stenosis(MS) with pulmonary hypertension was significantly lower (P＜0.01). (2)Linear correlation analysis showed that preoperative mPAP was correlated closely with C0 in the group of MS (r=－0.745,P＜0.05). (3)PAP and PVR decreased significantly after infusing sodium nitroprusside(0.5μg*min-1*kg-1) in both MS with mild pulmonary hypertension(mPAP＜35 mm Hg) and MS with severe pulmonary hypertension(mPAP≥35 mm Hg) groups(P＜0.01). C0 and Cm increased significantly in group of MI with mild pulmonary hypertension. Whereas C0 of MS with severe pulmonary hypertension didn't change significantly［(2.35±1.24) vs (2.24±1.53) ml/mm Hg，P＞0.05］. Cm increased significantly with decreasing of mPAP［(1.51±0.59) vs (1.81±0.77) ml/mm Hg］. Conclusion: The results showed different degree of pulmonary vascular remodeling in the rheumatic valvular disease with pulmonary hypertension. The degree of pulmonary arterial changes in patients with mitral stenosis is a major factor affecting the level of preoperative pulmonary arterial pressure. MS patients with pulmonary hypertension may have low response to the vasodilator.