【摘要】 目的超声心动图检测腺苷在急性血管扩张试验中扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应证的应用价值。方法选取先天性室间隔缺损并重度肺动脉高压患者68例,肘静脉注射腺苷75μg.kg-1.min-1,应用彩色多普勒超声心动图检测主动脉平均压、肺动脉平均压、肺动脉收缩压、肺动脉舒张压、肺循环阻力、体循环阻力、肺循环阻力/体循环阻力、肺动脉/主动脉收缩压、肺循环/体循环血流量,注射5 min后肺血管阻力下降>30%和肺动脉平均压下降>10%为急性血管扩张试验阳性。结果39例急性血管扩张试验阳性者,通过临床药物降压治疗有效后成功手术;29例药物试验阴性者继续降压治疗无效,均非手术适应证。结论腺苷急性血管扩张试验可以判断肺动脉高压的可逆性,为扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应证起到初步筛选的作用。更多还原

【Abstract】 Objective To evaluate the value of acute dilatation test of adenosine in patients with congenital ventricular septal defect(VSD) and severe pulmonary hypertension(PH) by color Doppler echocardiography in predicting surgical outcomes.Methods Sixty-eight patients with congenital VSD and severe PH were included.Mean systemic arterial pressure,pulmonary arterial mean pressure(PAMP),pulmonary arterial systolic pressure(PASP),pulmonary artery diastolic pressure(PADP),pulmonary vascular resistance(PVR),systemic vascular resistance(SVR),ratio of pulmonary/systemic vascular resistance(Rp/Rs),ratio of pulmonary/systemic systolic pressure(Pp/Ps),and ratio of pulmonary/systemic blood flow(Qp/Qs) were estimated by color Doppler echocardiography before,five minutes after intravenous infusion of adenosine 75 μg·kg-1·min-1.A positive test was defined as PVR decreased greater than 30% and PAMP over 10%,compared with baseline.Results Thirty-nine patients who were classified as positive test results underwent uneventful surgical procedures,while 29 patients with negative test results responded poorly to approaches for reducing pulmonary artery pressure.Conclusion The acute echocardiographic adenosine test can provide valuable information for surgical candidates in patients with VSD and severe pulmonary hypertension.更多还原