Gidding S S, Bessel M
Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614.
Pediatr Cardiol. 1993 Jul;14(3):135-9. doi: 10.1007/BF00795640.
To test the hypothesis that the clinical assessment of severity in ventricular septal defect would be more related to variables which define tissue oxygen delivery than variables which define the left-to-right shunt, cardiac catheterization data from 40 children < 3 years of age were assessed. Variables which were considered indicative of clinical severity included the need for digoxin and diuretics, resting heart rate, and severity of growth failure. Variables measured at cardiac catheterization, including those which related to oxygen transport, and assessment of left-to-right shunt, were considered independently. Patients receiving digoxin and diuretics were more tachycardic (142 +/- 18 vs. 111 +/- 26 beats/min, p < 0.001) and had lower superior vena cava oxygen saturation (64 +/- 6 vs. 69 +/- 5%, p < 0.01). Variation in heart rate (r2 = 0.46) was best explained by oxygen consumption, hemoglobin concentration, cardiac index, and pulmonary vascular resistance. Variation in growth failure (r2 = 0.15) was related only to the left ventricular forward stroke index. These data suggest that variables related to oxygen delivery, including oxygen consumption, hemoglobin concentration, cardiac index, forward stroke index, and superior vena cava oxygen saturation, are the major contributors to the clinical assessment of severity in ventricular septal defect.
室间隔缺损严重程度的临床评估与定义组织氧输送的变量的相关性，高于与定义左向右分流的变量的相关性，我们评估了40名3岁以下儿童的心脏导管检查数据。被认为可指示临床严重程度的变量包括是否需要使用地高辛和利尿剂、静息心率以及生长发育迟缓的严重程度。在心脏导管检查时测量的变量，包括那些与氧输送相关的变量以及对左向右分流的评估，被单独进行考量。接受地高辛和利尿剂治疗的患者心率更快（142±18对111±26次/分钟，p<0.001），上腔静脉血氧饱和度更低（64±6对69±5%，p<0.01）。心率变化（r2 = 0.46）最能由氧消耗、血红蛋白浓度、心脏指数和肺血管阻力来解释。生长发育迟缓的变化（r2 = 0.15）仅与左心室前向搏出指数有关。这些数据表明，与氧输送相关的变量，包括氧消耗、血红蛋白浓度、心脏指数、前向搏出指数和上腔静脉血氧饱和度，是室间隔缺损严重程度临床评估的主要影响因素。
