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目的:研究应用国产动脉导管未闭(PDA)封堵器介入治疗PDA后心脏重构的变化规律,评价培哚普利对PDA患者封堵后左心大小、功能和肺动脉收缩压的作用。方法:26例PDA患者中25例经国产封堵器封堵后选择经胸超声心动图(TTE)测得PDA5.0mm的成人患者(年龄>17岁)20例,按性别相等、年龄±5岁分成治疗组和对照组,2组均常规术前1d开始予肠溶阿司匹林200mg.d-1×1个月,然后100mg.d-1×5个月,治疗组加服培哚普利2mg.d-1×6个月。术前、术后6个月经TTE和心电图(ECG)检查。心室容积和射血分数采用面积长度法测定,连续多普勒根据三尖瓣反流估测肺动脉收缩压。结果:2组基础指标,如左房内径(LAD),左室舒张末内径(LVEDD),左室收缩末内径(LVESD),左室舒张末容积(LVEDV),左室收缩末容积(LVESV),左室搏出量(LVSV),肺动脉内径(PD),肺动脉收缩压(PSP)均差异无统计学意义(P>0.05)。培哚普利治疗6个月后,LVEDD、LVESD、LVEDV、LVESV、LVSV、LVEF、FS、PD、PSP治疗组均较对照组有明显的改善(均P<0.05)。结论:培哚普利能明显改善PDA封堵术后患者的左心功能和形态,并使肺动脉内径缩小、肺动脉收缩压降低,临床症状明显改善。
OBJECTIVE: To study the changes of cardiac remodeling after PDA treated with domestic PDA, and to evaluate the effect of perindopril on left ventricular size, function and pulmonary artery systolic pressure after occlusion in PDA patients. Methods: Twenty - five adult PDA patients (age> 17 years) with PDA5.0mm were selected by transthoracic echocardiography (TTE). Twenty - five patients with PDA were enrolled in this study. The patients were divided into the treatment group and the control group. The patients in the two groups were given routine aspirin 200 mg.d-1 x 1 month, and then 100 mg.d-1 x 5 months. The patients in the two groups were treated with perindopril 2 mg .d-1 × 6 months. Preoperative and postoperative 6 months by TTE and electrocardiogram (ECG) examination. Ventricular volume and ejection fraction were determined by the area length method, and continuous Doppler was used to estimate pulmonary artery systolic pressure based on tricuspid regurgitation. Results: Two groups of basic indexes such as LAD, LVEDD, LVESD, LVEDV, LVESV, , Left ventricular stroke volume (LVSV), pulmonary artery diameter (PD) and pulmonary artery systolic pressure (PSP) were not significantly different (P> 0.05). Six months after perindopril treatment, LVEDD, LVESD, LVEDV, LVESV, LVSV, LVEF, FS, PD and PSP treatment groups were significantly improved compared with the control group (all P <0.05). CONCLUSION: Perindopril can significantly improve left ventricular function and morphology in patients with PDA closure. The diameter of the pulmonary artery is reduced and the systolic pressure of the pulmonary artery is decreased. The clinical symptoms are significantly improved.