CAJ | 학술논문

目的采用放射性核素显像及肺动脉造影分析心外管道全腔静脉肺动脉连接( extracardiac total cavopulmonary connection,ETCPC)术后5年肺血管发育的演变情况.方法 43例ETCPC患者,通过右心导管及肺动脉造影计算术后早期及术后5年的肺动脉指数(pulmonary arterial index,PAI)、肺小血管阻力(pulmonary vascular resistance,PVR),测量腔静脉压(central venous pressure,CVP)及动脉血氧饱和度(arterial oxygenation saturation,SatO2％),应用放射性核素显像计算术后患者肺血灌注量,观察术后肺血管发育.结果随访期指标与术后早期相比,PAI显著增加(t=2.41,P＜0.05),PVR显著下降(t=2.08,P＜0.05),CVP显著下降(t=2.69,P＜0.05),SatO2％差异无统计学意义.放射性核素肺灌注检查显示,与术后早期比较,随访期肺总核素计数值及右肺/左肺灌注比值差异无统计学意义(t=0.38,P＞0.05及t=1.12,P＞0.05),全肺上段/下段比值显著下降(t=2.54,P＜0.05).结论 Fontan循环的弱搏动血流仍可推动肺血管的继续发育,但术后中期肺血管阻力下降不会导致肺血灌注量及氧供的增加,可能与肺动静脉短路大量形成有关.
목적 채용방사성핵소현상급폐동맥조영분석심외관도전강정맥폐동맥련접( extracardiac total cavopulmonary connection,ETCPC)술후5년폐혈관발육적연변정황.방법 43례ETCPC환자,통과우심도관급폐동맥조영계산술후조기급술후5년적폐동맥지수(pulmonary arterial index,PAI)、폐소혈관조력(pulmonary vascular resistance,PVR),측량강정맥압(central venous pressure,CVP)급동맥혈양포화도(arterial oxygenation saturation,SatO2％),응용방사성핵소현상계산술후환자폐혈관주량,관찰술후폐혈관발육.결과 수방기지표여술후조기상비,PAI현저증가(t=2.41,P＜0.05),PVR현저하강(t=2.08,P＜0.05),CVP현저하강(t=2.69,P＜0.05),SatO2％차이무통계학의의.방사성핵소폐관주검사현시,여술후조기비교,수방기폐총핵소계수치급우폐/좌폐관주비치차이무통계학의의(t=0.38,P＞0.05급t=1.12,P＞0.05),전폐상단/하단비치현저하강(t=2.54,P＜0.05).결론 Fontan순배적약박동혈류잉가추동폐혈관적계속발육,단술후중기폐혈관조력하강불회도치폐혈관주량급양공적증가,가능여폐동정맥단로대량형성유관.
Objective To study the pulmonary arterial development over five years in patients underwent extracardiac total cavopulmonary connection (ETCPC).Methods 43 survived patients,who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation.Central venous pressure (CVP) and arterial oxygenation saturation (SatO2 ％ ) were measured by right cardiac catheter,pulmonary arterial index (PAI) and pulmonary vascular resistance (PVR) were calculated.Pulmonary blood distribution were measured and calculated by 99m Tc-MAA perfusion imaging.Results The PAI and PVR of the follow-up group reduced significantly ( t =2.41,P ＜ 0.05 ; t =2.08,P ＜ 0.05 ),CVP also reduced significantly ( t =2.69,P ＜ 0.05 ),but SatO2 ％ did not changed significantly.Total radionuclide counts and the ratio of rightorleft pulmonary perfusion did not change significantly.( t =0.38,P ＞ 0.05 ;t =1.12,P ＞ 0.05 ),but the ratio of the superior and inferior lobe decreased significantly( t =2.54,P ＜ 0.05 ).Conclusion The weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development.However,the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply,which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.