2019 年第 8 期 第 14 卷

老年房间隔缺损患者封堵术后中远期持续性肺动脉高压的分析

Long-term persistent pulmonary hypertension after atrial septal defect occlusion in elderly patients

作者：于惠梅张纯科雨彤李晓明吴山安博静姚璐蝉张蔚聪

英文作者：

单位：100029首都医科大学附属北京安贞医院超声科北京市心肺血管疾病研究所

英文单位：

关键词：房间隔缺损；肺动脉高压

英文关键词：

• 摘要：

• 【摘要】目的    观察老年房间隔缺损患者封堵术后持续性肺动脉高压的发生情况。方法    连续性观察2016年7月至2018年1月于首都医科大学附属北京安贞医院成功接受封堵治疗的老年房间隔缺损患者14例，其中男4例、女10例,平均年龄（58±5）岁。根据术前经胸超声心动图结果将患者分为肺动脉高压组（5例）及非肺动脉高压组（9例）。比较2组患者术前与术后12个月右心功能参数，分析肺动脉压力与右心功能参数的相关性，观察患者封堵术后随访12个月的临床结局。结果    术前，肺动脉高压组肺动脉收缩压明显高于非肺动脉高压组，差异均有统计学意义（P＜0.05）。术后12个月，肺动脉高压组右心室舒张末期容积、右心室收缩末期容积明显大于非肺动脉高压组［（57±11）ml比（41±15）ml、（41±9）ml比（22±14）ml］，右心室射血分数明显低于非肺动脉高压组［（29±9）%比（50±13）%］，差异均有统计学意义（均P＜0.05）。术后12个月，肺动脉收缩压与右心室射血分数呈负相关（r=-0.749，P＜0.001），与右心室舒张末期容积和右心室收缩末期容积均呈正相关（r=0.810、0.873，均P＜0.001）。肺动脉高压组 1例患者于封堵术后12个月时死于急性心肌梗死，其余4例患者出现持续性肺动脉高压，非肺动脉高压组患者随访12个月无不良事件发生。结论    老年房间隔缺损封堵治疗患者，随着肺动脉压力的增加，右心室整体功能受损和右心室重构程度越严重，预后越差；相反，肺动脉压力越小，对右心室整体功能影响较小，右心室重构不明显，预后较好。

• 【Abstract】Objective    To observe the occurrence of persistent pulmonary hypertension after occlusion in elderly patients with atrial septal defect. Methods    From July 2016 to January 2018, 14 elderly patients with atrial septal defect who successfully completed occlusion surgery in Beijing Anzhen Hospital, Capital Medical University, including 4 males and 10 females, with an average age of (58±5) years, were sequentially enrolled. According to preoperative transthoracic echocardiography, the patients were divided into pulmonary hypertension(PH) group(5 cases) and non-PH group(9 cases). Right heart function parameters were recorded before and 12 months after surgery. Correlation between pulmonary artery pressure and right heart function parameters was analyzed. Clinical outcomes of the patients were observed during 12 months follow-up. Results    Pulmonary systolic pressure before surgery in PH group was significantly higher than that in non-PH group(P＜0.05). Twelve months after surgery, right ventricular end-diastolic volume and right ventricular end-systolic volume in PH group were significantly greater［（57±11）ml vs （41±15）ml, （41±9）ml vs （22±14）ml］ and right ventricular ejection fraction was significantly lower［（29±9）% vs （50±13）%］ than those in non-PH group(all P＜0.05). Pulmonary systolic pressure was negatively correlated with right ventricular ejection fraction(r=-0.749, P＜0.001) and positively correlated with right ventricular end-diastolic volume and right ventricular end-systolic volume(r=0.810, 0.873; both P＜ 0.001). One patient in PH group died of acute myocardial infarction and 4 patients developed persistent PH during follow-up. No adverse event occurred in non-PH group. Conclusion    In elderly patients with atrial septal defect occlusion, right ventricular function decline and right ventricular remodeling deteriorate with the increase of pulmonary artery pressure; low pulmonary artery pressure indicates better prognosis.