5岁以下儿童房间隔缺损大小与肺动脉压力关系

摘要

目的：探讨5岁以下儿童继发孔房间隔缺损（ASD）大小与肺动脉压力的关系。方法2000年4月-2011年1月沈阳军区总医院收治5岁以下 ASD 患者189例，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，分析患者性别、年龄、身高、体重及体表面积、房缺直径、心胸比值、肺动脉收缩压、舒张压和平均压，术后超声心动图随访1年，并按缺损直径分组。结果189例中，男性77例，女性112例，男女之比为1∶1．5，平均年龄（4．1±0．9）岁（2～5岁），平均体重（17．2±3．6）kg （10．0～30．0 kg），平均身高（104．9±9．2）cm（77～135 cm），缺损直径5～29 mm，平均（12．6±4．8）mm，体表面积矫正缺损直径为5．3～38．9 mm/m2，平均（18．0±7．0）mm/m2，肺动脉收缩压15～67 mmHg，平均（41．1±8．9）mmHg。159例（89．4%）患者心导管测量肺动脉高压，所有患者术前和术后1、3、6、12个月超声估测肺动脉压均正常。 ASD 直径与肺动脉压力之间无相关性（P <0．05）。结论5岁以下 ASD 患儿，心导管检查所测肺动脉压力与缺损直径无关。心导管检查过程中所测肺动脉压力可能受全麻药物氯胺酮影响，心导管测量的肺动脉压力高于超声估测的肺动脉压力。%Objective to investigate the relationship between the size of ostium secondary atrial septal defect (ASD) and the pulmonary arterial pressure (PAP) in children less than 5 years of age. Methods During the period from April 2000 to January 2011, a total of 189 child patients less than 5 years of age with ostium secondary ASD were admitted to General Hospital of Shenyang Military Command. Under general anaesthesia with ketamine cardiac catheterization was performed, PAP was measured, and percutaneous occlusion of ASD was carried out in all patients. The clinical indexes, including sex, age, body height, body weight, body surface area, diameter of ASD defect, heart- to- thorax ratio, the systolic, diastolic and mean pressure of the pulmonary artery, etc. were determined. The patients were followed up for one year and postoperative cardiac ultrasonography was performed to check the results. The patients were divided into groups according to the defect size. Results The 189 patients consisted of 77 males and 112 females with a male-to-female ratio of 1 ∶ 1.5. The mean age was (4.1 ± 0.9) years old, ranging from 2 to 5 years old. The mean weight was (17.2 ± 3.6) kg, ranging from 10.0 to 30.0 kg. The mean height was (104.9 ± 9.2) cm, ranging from 77 to 135 cm. The mean body surface area (BSA) was (0.71 ± 0.10) m2, ranging from 0.46 to 1.02 m2. The mean size of ASD was (12.6 ± 4.8) mm, ranging from 5 to 29 mm. The mean size of ASD, which was modified by BSA, was (18.0 ± 7.0) mm/m2, ranging from 5.3 to 38.9 mm/m2. The mean systolic PAP was (41.1 ± 8.9) mmHg with a range of 15 - 67 mmHg. The mean diastolic PAP was (16.8 ± 6.5) mmHg with a range of 3 - 45 mmHg. The mean PAP was (24.9 ± 6.7) mmHg with a range of 12 - 48 mmHg. One hundred and fifty- nine patients (89.4%) had pulmonary arterial hypertension (PAH) which was determined by right heart catheterization, but no patient showed PAH when the pulmonary arterial pressure was measured by echocardiography before the procedure as well as 1, 3, 6, 12 months after the procedure. No definite correlation existed between the size of ASD and the pulmonary artery pressure (P > 0.05). Conclusion Pulmonary artery pressure measured by right heart catheterization has no definite correlation with the size of ASD in children less than 5 years of age. Pulmonary artery pressure obtained from right heart catheterization is higher than that determined by cardiac ultrasonography, which may be caused by the effect of ketamine when general anaesthesia is used in performing right heart catheterization.