Sen Supratim, Bandyopadhyay Biswajit, Eriksson Peter, Chattopadhyay Amitabha
Department of Pediatric Cardiology, RN Tagore International Institute of Cardiac Sciences, Kolkata, India.
Congenit Heart Dis. 2012 Sep-Oct;7(5):423-32. doi: 10.1111/j.1747-0803.2012.00640.x. Epub 2012 Apr 3.
Previous studies have seldom compared functional capacity in children following Fontan procedure alongside those with Glenn operation as destination therapy. We hypothesized that Fontan circulation enables better midterm submaximal exercise capacity as compared to Glenn physiology and evaluated this using the 6-minute walk test.
Fifty-seven children aged 5-18 years with Glenn (44) or Fontan (13) operations were evaluated with standard 6-minute walk protocols.
Baseline SpO(2) was significantly lower in Glenn patients younger than 10 years compared to Fontan counterparts and similar in the two groups in older children. Postexercise SpO(2) fell significantly in Glenn patients compared to the Fontan group. There was no statistically significant difference in baseline, postexercise, or postrecovery heart rates (HRs), or 6-minute walk distances in the two groups. Multiple regression analysis revealed lower resting HR, higher resting SpO(2) , and younger age at latest operation to be significant determinants of longer 6-minute walk distance. Multiple regression analysis also established that younger age at operation, higher resting SpO(2) , Fontan operation, lower resting HR, and lower postexercise HR were significant determinants of higher postexercise SpO(2) . Younger age at operation and exercise, lower resting HR and postexercise HR, higher resting SpO(2) and postexercise SpO(2) , and dominant ventricular morphology being left ventricular or indeterminate/mixed had significant association with better 6-minute work on multiple regression analysis. Lower resting HR had linear association with longer 6-minute walk distances in the Glenn patients.
Compared to Glenn physiology, Fontan operation did not have better submaximal exercise capacity assessed by walk distance or work on multiple regression analysis. Lower resting HR, higher resting SpO(2) , and younger age at operation were factors uniformly associated with better submaximal exercise capacity.
以往研究很少将接受Fontan手术的儿童与接受Glenn手术作为最终治疗方案的儿童的功能能力进行比较。我们假设与Glenn生理状态相比，Fontan循环能使中期次最大运动能力更好，并使用6分钟步行试验对此进行评估。
对57名年龄在5至18岁之间接受Glenn手术（44例）或Fontan手术（13例）的儿童采用标准的6分钟步行方案进行评估。
10岁以下的Glenn患者基线SpO₂显著低于Fontan患者，而在年龄较大的儿童中，两组相似。与Fontan组相比，Glenn患者运动后SpO₂显著下降。两组在基线、运动后或恢复后心率（HR）以及6分钟步行距离方面无统计学显著差异。多元回归分析显示，静息心率较低、静息SpO₂较高以及最近一次手术时年龄较小是6分钟步行距离较长的重要决定因素。多元回归分析还确定，手术时年龄较小、静息SpO₂较高、Fontan手术、静息心率较低以及运动后心率较低是运动后SpO₂较高的重要决定因素。手术和运动时年龄较小、静息心率和运动后心率较低、静息SpO₂和运动后SpO₂较高以及优势心室形态为左心室或不确定/混合型在多元回归分析中与更好的6分钟运动有显著关联。在Glenn患者中，静息心率较低与6分钟步行距离较长呈线性相关。
与Glenn生理状态相比，Fontan手术在通过步行距离评估的次最大运动能力或多元回归分析中的运动能力方面并无更好表现。静息心率较低、静息SpO₂较高以及手术时年龄较小是与更好的次最大运动能力一致相关的因素。
