术前血氧饱和度作为房间隔缺损手术后肺动脉高压预测指标的重要性。

The importance of preoperative oxygen saturation as a predictor of pulmonary arterial hypertension after surgery of atrial septal defects.

作者信息

Park Han Ki, Shin Hong Ju, Park Young Hwan, Ma Bo Gyoung

机构信息

Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.

Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea

出版信息

Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):424-30. doi: 10.1093/icvts/ivw162. Epub 2016 May 24.

DOI:10.1093/icvts/ivw162

PMID:27222001

Abstract

OBJECTIVES

There is no concrete predictor of the change of pulmonary arterial pressure after surgical closure of an atrial septal defect (ASD) in patients with pulmonary arterial hypertension (PAH). The aim of this study was to investigate the role of preoperative room air arterial oxygen saturation (SaO2) (arterial blood gas data) as a predictor of postoperative PAH.

METHODS

The medical records of 36 patients [>20 years, mean pulmonary arterial pressure (mPAP) ≥25 mmHg] who underwent surgical closure of an ASD between March 2004 and January 2014 were retrospectively reviewed.

RESULTS

The median age was 47 years (range, 24.6-65.9 years) and mPAP was 38 ± 14 mmHg. The mean pulmonary vascular resistance (Rp) was 3.9 ± 4.2 Wood units, and fenestration was performed in 12 (33%) patients. Only 1 patient received anti-PAH medication preoperatively. The median follow-up period was 4 years (range, 0-10 years). There were two hospital deaths, one of which was related to PAH. At the last follow-up, PAH (estimated tricuspid regurgitation velocity >3 m/s) existed in 7 patients (19%), and 10 patients (28%) were receiving anti-PAH medications (considered as clinical PAH). Univariate analysis for persistent clinical PAH revealed that mPAP, Qp/Qs, Rp, room air arterial oxygen saturation and postoperative functional class were significant risk factors. Only SaO2 remained a significant risk factor in multivariate analysis (P = 0.03).

CONCLUSIONS

Preoperative room air SaO2 is a useful predictor of persistent PAH in adult patients undergoing surgical closure of an ASD.

摘要

目的

对于患有肺动脉高压（PAH）的房间隔缺损（ASD）患者，在手术闭合ASD后，尚无预测肺动脉压力变化的具体指标。本研究旨在探讨术前室内空气动脉血氧饱和度（SaO2）（动脉血气数据）作为术后PAH预测指标的作用。

方法

回顾性分析2004年3月至2014年1月期间接受ASD手术闭合的36例患者（年龄>20岁，平均肺动脉压[mPAP]≥25 mmHg）的病历。

结果

中位年龄为47岁（范围24.6 - 65.9岁），mPAP为38±14 mmHg。平均肺血管阻力（Rp）为3.9±4.2伍德单位，12例（33%）患者进行了开窗术。仅1例患者术前接受了抗PAH药物治疗。中位随访期为4年（范围0 - 10年）。有2例住院死亡，其中1例与PAH相关。在最后一次随访时，7例患者（19%）存在PAH（估计三尖瓣反流速度>3 m/s），10例患者（28%）正在接受抗PAH药物治疗（视为临床PAH）。对持续性临床PAH的单因素分析显示，mPAP、Qp/Qs、Rp、室内空气动脉血氧饱和度和术后功能分级是显著危险因素。在多因素分析中，只有SaO2仍然是显著危险因素（P = 0.03）。