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目的探讨在动脉导管未闭(PDA)合并重症肺动脉高压(PAH)患儿中,封堵试验对PAH性质的判定及介入治疗的意义。方法 2008年7月至2014年10月南京医科大学附属儿童医院收治5例单纯PDA合并重症PAH患儿,回顾分析其心导管资料、急性肺血管扩张试验前后相关参数,以及封堵试验前后肺动脉收缩压、主动脉收缩压、肺血管阻力指数、主动脉血氧饱和度变化。结果 5例患儿根据心导管检查资料判断,1例PAH性质为动力性PAH,4例PAH性质难以判断;急性肺血管扩张试验判断,4例符合动力性PAH改变,1例不完全符合;封堵试验结果判断,5例均符合动力性PAH改变。5例患儿成功完成介入治疗,术后肺动脉压力进一步下降,远期随访效果良好。结论对于PDA合并重症PAH患儿,封堵试验可对PAH性质作出诊断,如判定为动力性PAH,可同时完成介入治疗,能有效避免心导管检查及急性肺血管扩张试验评价PAH性质的局限性。
OBJECTIVE: To investigate the effect of blockade on the determination of PAH in children with patent ductus arteriosus (PDA) complicated with severe pulmonary hypertension (PAH) and the significance of interventional therapy. Methods From July 2008 to October 2014, 5 cases of simple PDA complicated with severe PAH were admitted to Children’s Hospital of Nanjing Medical University. Cardiac catheterization data, parameters before and after acute pulmonary vasodilatation test, and pulmonary artery contraction before and after the blockade test were retrospectively analyzed. Pressure, aortic systolic pressure, pulmonary vascular resistance index, changes in aortic oxygen saturation. Results According to the data of cardiac catheterization, 5 cases were diagnosed according to the data of cardiac catheterization. One case of PAH was dynamic PAH and the other 4 cases were difficult to determine the nature of PAH. The acute pulmonary vasodilatation test showed that 4 cases were consistent with dynamic PAH changes and 1 case was not completely matched. Block test results to determine, 5 patients were in line with dynamic PAH changes. 5 cases of children successfully completed the interventional treatment, postoperative pulmonary artery pressure decreased further, long-term follow-up effect is good. Conclusion For PDA with severe PAH in children, blockade test can diagnose the nature of PAH, such as the determination of dynamic PAH, interventional treatment can be completed at the same time, can effectively avoid the limitations of cardiac catheterization and acute pulmonary vascular dilatation test to evaluate the nature of PAH .