【摘要】 目的:通过对200例先天性心脏病(CHD)患儿心脏病手术前慢性充血性心力衰竭(CHF)及肺动脉高压(PH)的研究,探讨CHD患儿术前的CHF、PH发生率,诊断方法及干预。方法:通过改良Ross心力衰竭评分,血浆氨基末端脑利钠肽前体(NT-proBNP)、内皮素-1(ET-1)、心肌肌钙蛋白Ⅰ(cTnⅠ)检测,超声心动图PH测定,对CHF、PH做出综合评定并计算其发生率。对术前CHF、PH患儿提出干预建议。结果:CHD术前CHF、PH的发生率分别为17.5%(35例)和11.5%(23例)。CHF组与对照组Ross心力衰竭评分、NT-proBNP、cTnⅠ比较差异均有统计学意义(P<0.05);PH组与对照组NT-proBNP比较差异有统计学意义(P<0.05),PH组与对照组cTnⅠ比较差异无统计学意义(P>0.05)。CHF组及PH组ET-1均无1例异常升高。结论:改良Ross心力衰竭评分,超声心动图PH测定及NT-proBNP、cTnⅠ检测对CHD术前CHF及PH可做出准确的判断。术前CHF、PH患儿进行相应的干预对提高日后手术成功率及患儿的生存质量具有积极的意义。更多还原

【Abstract】 Objective: To explore the incidence rates,diagnostic methods,and interventional measures of congestive heart failure( CHF) and pulmonary hypertension( PH) by researching CHF and PH in 200 children with congenital heart disease( CHD) before surgery.Methods: CHF and PH were evaluated comprehensively through modified Ross CHF score,detection of plasma N-terminal proBNP( NT-proBNP),endothelin-1( ET-1),cardiac troponin Ⅰ( cTnⅠ),and PH detection with ultrasonic cardiogram,then the incidence rates of CHF and PH were calculated. Interventional measures and suggestions were put forward according to children with CHF and PH before surgery. Results: The incidence rates of CHF and PH in CHD children before surgery were 17. 5%( 35 children) and 11. 5%( 23 children),respectively. There were statistically significant differences in Ross CHF score,NT-proBNP,and cTnⅠ levels between CHF group and control group( P < 0. 05); there was statistically significant difference in NT-proBNP level between PH group and control group( P <0. 05),there was no statistically significant difference in cTnⅠ level between PH group and control group( P > 0. 05). ET-1 level didn’t’t increase abnormally in CHF group and PH group. Conclusion: Accurate diagnosis of CHF and PH in CHD children before surgery can be obtained by modified Ross CHF score,detection of plasma N-terminal NT-proBNP and cTnⅠ,and PH detection with ultrasonic cardiogram. Preoperative intervention has active significance for improving surgical successful rate and quality of life for children with CHF and PH before surgery.更多还原