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目的 :探讨心导管检查、急性肺血管扩张试验及封堵试验在动脉导管未闭(PDA)合并中重度肺动脉高压(PAH)中对PAH性质判断的意义。方法 :回顾23例单纯PDA合并中重度PAH患儿心导管检查获取的生理资料,分析急性肺血管扩张试验前后Qp/Qs、Rp/Rs、Pp/Ps、PAWP、PVRI及主动脉血氧饱和度变化以及封堵试验前后Pp、Ps、PVRI及主动脉血氧饱和度变化。结果:23例患儿心导管检查后,根据Qp/Qs、Rp/Rs、Pp/Ps、PAWP、PVRI等19例判断为动力性PAH,4例重度PAH性质难以判断;5例重度PAH患儿均行急性肺血管扩张试验,4例结果符合动力性PAH改变,1例不完全符合;23例均行封堵试验,结果均符合动力性PAH改变;23例患儿完成封堵治疗,术后随访心脏大小、肺动脉压力均恢复正常。结论:详细的心导管检查获取必要的生理资料对PAH性质初步判断,结合急性肺血管扩张试验、封堵试验作出综合判断,能有效避免单一的血流动力学参数评价PAH性质的局限性,从而获得较好的临床效果。
Objective: To investigate the significance of cardiac catheterization, acute pulmonary vasodilatation test and occlusion test in judging the nature of PAH in patent ductus arteriosus (PDA) combined with moderate and severe pulmonary hypertension (PAH). Methods: The physiological data obtained from cardiac catheterization in 23 cases of simple PDA complicated with moderate and severe PAH were retrospectively analyzed. The changes of Qp / Qs, Rp / Rs, Pp / Ps, PAWP, PVRI and aortic oxygen saturation before and after acute pulmonary vasodilatation Changes and changes of Pp, Ps, PVRI and aorta oxygen saturation before and after blockade test. Results: After cardiac catheterization in 23 children, the dynamic PAH was judged according to Qp / Qs, Rp / Rs, Pp / Ps, PAWP and PVRI, and 4 severe PAH were difficult to judge. Acute pulmonary vasodilatation tests were performed in 4 cases, and the results were consistent with dynamic changes in PAH, 1 case did not fully meet; 23 cases were performed blockade test, the results were consistent with dynamic changes in PAH; 23 cases of children complete closure therapy, postoperative Follow-up heart size, pulmonary artery pressure returned to normal. CONCLUSIONS: Detailed cardiac catheterization obtains the necessary physiological data to judge the nature of PAH, combined with acute pulmonary vasodilatation test and occlusion test to make a comprehensive judgment, which can effectively avoid the limitations of single hemodynamic parameters in evaluating the properties of PAH Get better clinical results.