吸氧可降低 Fontan 手术后成人患者的中心静脉压。

Oxygen inhalation decreases the central venous pressure in adult patients late after Fontan operations.

机构信息

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Cardiovascular Intensive Care, Fukuoka Children's Hospital, Fukuoka, Japan.

出版信息

J Cardiol. 2024 Sep;84(3):195-200. doi: 10.1016/j.jjcc.2024.02.010. Epub 2024 Feb 22.

DOI:10.1016/j.jjcc.2024.02.010

PMID:38401702

Abstract

BACKGROUND

Elevated central venous pressure (CVP) and decreased arterial oxygen saturation (SaO) are the characteristics of patients after Fontan operations and determine morbidity and mortality in the long-term. Oxygen inhalation therapy theoretically increases SaO and may decrease the elevated CVP in these patients. However, there is no previous study to support this hypothesis. This study aimed to determine the acute effects of oxygen inhalation on the hemodynamics of adult patients late after Fontan operations using cardiac catheterization.

METHODS

This study enrolled 58 consecutive adult patients (median age, 30 years; female, n = 24) who had undergone Fontan operations. We assessed the hemodynamic changes during oxygen inhalation (2 L/min) with a nasal cannula in cardiac catheterization. We divided the studied patients into two groups according to the reduction in CVP during oxygen inhalation using the median value: responders (>2 mmHg) and non-responders (≤2 mmHg). Clinical characteristics of the responders to oxygen inhalation were investigated with uni- and multivariate analyses.

RESULTS

SaO increased from 93.3 % (91.3-94.5 %) to 97.5 % (95.2-98.4 %) (p < 0.001) and CVP decreased from 12 mmHg (11-14 mmHg) to 10 mmHg (9-12 mmHg) (p < 0.001) after oxygen inhalation. There was a weak but significant correlation between the increase in SaO and the decrease in CVP (R = 0.29, p = 0.025). Pulmonary blood flow increased from 4.1 L/min (3.5-5.0 L/min) to 4.4 L/min (3.7-5.3 L/min) (p = 0.007), while systemic blood flow showed no significant changes. A multivariate analysis revealed that high baseline CVP was associated with a larger decrease in CVP (>2 mmHg) after oxygen inhalation.

CONCLUSIONS

Oxygen inhalation increased SaO and decreased CVP, especially in patients with high baseline CVP. Further studies with home oxygen therapy are needed to investigate the long-term effects of oxygen inhalation in adult patients who underwent Fontan operations.

摘要

背景

中心静脉压升高（CVP）和动脉血氧饱和度降低（SaO）是 Fontan 手术后患者的特征，决定了长期的发病率和死亡率。吸氧治疗理论上可以提高 SaO，并可能降低这些患者的升高的 CVP。然而，目前还没有研究支持这一假说。本研究旨在通过心导管检查确定吸氧对 Fontan 手术后晚期成人患者血流动力学的急性影响。

方法

本研究纳入了 58 例连续的成年 Fontan 术后患者（中位年龄 30 岁；女性 24 例）。我们在心导管检查中使用鼻导管评估吸氧（2L/min）时的血流动力学变化。我们根据 CVP 在吸氧过程中的降低情况，使用中位数将研究患者分为两组：反应者（>2mmHg）和非反应者（≤2mmHg）。采用单变量和多变量分析研究吸氧反应者的临床特征。

结果

SaO 从 93.3%（91.3-94.5%）增加到 97.5%（95.2-98.4%）（p<0.001），CVP 从 12mmHg（11-14mmHg）降低到 10mmHg（9-12mmHg）（p<0.001）。SaO 的增加与 CVP 的降低之间存在微弱但显著的相关性（R=0.29，p=0.025）。肺血流量从 4.1L/min（3.5-5.0L/min）增加到 4.4L/min（3.7-5.3L/min）（p=0.007），而体循环血流量无明显变化。多变量分析显示，高基线 CVP 与吸氧后 CVP 降低幅度较大（>2mmHg）相关。