CAJ | 학술논문

目的通过数学模型,分析附加肺血流(additional pulmonary blood flow,APBF)的意义及其流量控制.方法建立APBF-BCPS模型,计算机分析APBF对氧供(oxygen delivery,DO2)的影响,APBF 流量对中心静脉压(central venous pressure,CVP)以及动脉氧饱和度(SaO2)的影响.结果 APBF对机体的作用取决于上腔静脉血流量与下腔静脉血流量之比(QSVC/QIVC),QSVC/QIVC＞0.3时,保留APBF降低组织氧供;QSVC/QIVC＜0.3时,适当APBF有助于提高组织氧供.APBF流量增加和CVP增加呈线型相关,斜率与肺血管阻力正相关,用CVP的增加来衡量APBF流量是一种可行的方法.氧饱和度的增加与APBF流量及CVP的增加不是线型关系,用 SaO2判断APBF流量可能引起误导.随年龄增加,QSVC/QIVC逐渐降低,BCPS加上适当的APBF有助于提高氧供.随年龄增加,无APBF的BCPS的患儿,QSVC/QIVC逐渐降低,氧供呈下降趋势;合并肺动静脉瘘则氧供急降.结论适龄且肺血管发育尚可患儿(QSVC/QIVC＞0.3),消除APBF能在心排血量相等情况下改善氧供.肺血管发育差(QSVC/QIVC＜0.3)或年龄偏大患儿,需要适当APBF提高氧供.单纯BCPS循环远期氧供呈逐渐恶化趋势,对于选择BCPS作为最终术式的病例,建议保留APBF.
목적 통과수학모형,분석부가폐혈류(additional pulmonary blood flow,APBF)적의의급기류량공제.방법 건립APBF-BCPS모형,계산궤분석APBF대양공(oxygen delivery,DO2)적영향,APBF 류량대중심정맥압(central venous pressure,CVP)이급동맥양포화도(SaO2)적영향.결과 APBF대궤체적작용취결우상강정맥혈류량여하강정맥혈류량지비(QSVC/QIVC),QSVC/QIVC＞0.3시,보류APBF강저조직양공;QSVC/QIVC＜0.3시,괄당APBF유조우제고조직양공.APBF류량증가화CVP증가정선형상관,사솔여폐혈관조력정상관,용CVP적증가래형량APBF류량시일충가행적방법.양포화도적증가여APBF류량급CVP적증가불시선형관계,용 SaO2판단APBF류량가능인기오도.수년령증가,QSVC/QIVC축점강저,BCPS가상괄당적APBF유조우제고양공.수년령증가,무APBF적BCPS적환인,QSVC/QIVC축점강저,양공정하강추세;합병폐동정맥루칙양공급강.결론 괄령차폐혈관발육상가환인(QSVC/QIVC＞0.3),소제APBF능재심배혈량상등정황하개선양공.폐혈관발육차(QSVC/QIVC＜0.3)혹년령편대환인,수요괄당APBF제고양공.단순BCPS순배원기양공정축점악화추세,대우선택BCPS작위최종술식적병례,건의보류APBF.
Objective The bidirectional cavopulmonary shunt (BCPS) is a major step in the staged palliation of functionally univentricular heart defects.Whether to preserve of additional pulmonary blood flow (APBF) has been a highly controversial issue.The purpose is to mathematical model and set out to determine the significa advantages and disadvantages of bidirectional cavopulmonary shunt with additional pulmonary blood flow:a theoretical analysis nce of APBF and the appropriate APBF ratio.Methods We used models of the univentricular circulation after the bidirectional cavopulmonary anastomosis with additional pulmonary blood and to computational analyze the impact of APBF on oxygen delivery,APBF flow on the CVP and SaO2.Results The influence of APBF depends on the ratio of superior vena cava flow to inferior vena cava flow ( QSVC/QIVC ).For QSVC/QIVC ＞ 0.3,APBF may be associated with decreased oxygen delivery.For QSVC/QIVC ＜ 0.3,appropriate APBF may be associated with increased oxygen delivery.A linear relationship exists between the increase of APBF and CVP,and the slope was depended on the value of pulmonary vascular resistance.Estimating APBF from CVP measurements may be a feasible method.A nonlinear relationship between the increase of APBF and oxygen saturation,and estimating APBF from SaO2 measurements may result in errors.BCPS and appropriate APBF may optimal the oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who accepted BCPS without APBF,there is a decreasing tendency of oxygen delivery with the increase of age and the decrease in QSVC/QIVC.For patients who suffered pulmonary arterivenous malformation,there is a more obvious decrease in oxygen delivery.Conclusion For patients under age who has normal pulmonary vascularbed ( that is,QSVC/QVC ＞ 0.3),elimination of additional pulmonary blood flow can improve the oxygen delivery under a given cardiac output.For patients who with hypoplastic pulmonary vascular or in older patients under age,APBF is necessary to improve oxygen delivery.For patients who have to accept BCPS as the final procedure,preserving of APBF is suggested.