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目的分析动脉导管的存在对肺血少型先天性心脏病(congenital heart defect,CHD)肺血管发育的影响及临床意义。方法 18例肺血少型CHD患儿,其中肺动脉闭锁10例,肺动脉狭窄8例;依据是否合并动脉导管未闭(patent ductus arteriosus,PDA)分为2组,10例(肺动脉闭锁9例、肺动脉狭窄1例)合并PDA者为PDA组,8例(肺动脉闭锁1例、肺动脉狭窄7例)未合并PDA者为NPDA组。观察2组患儿一般情况及肺组织病理改变情况,采用形态半定量法测量2组肺细小动脉中膜厚度百分比(percentage of media thickness,MT%)、中膜面积百分比(percentage of media section area,MS%)、肺小血管密度(numbers of vascular per square centimeter,VPSC)和平均肺泡数(mean alveolar munber,MAN)。结果 2组年龄、经皮血氧饱和度、红细胞压积、血红蛋白水平及心胸比率、肺动脉指数比较差异无统计学意义(P>0.05);2组泡内肺小动脉管腔均迂曲、扩张,静脉曲张样改变,管壁弹力组织层变薄,或有肺内小动静脉瘘形成;PDA组MT%[(15.4±6.3)%]、MS%[(0.2±0.1)%]、VPSC[(1.5±0.9)个/mm2]、MAN[(65.3±22.7)个/mm2]与NPDA组[(15.3±5.6)%、(0.2±0.1)%、(1.8±0.5)个/mm2、(63.1±17.3)个/mm2]比较差异无统计学意义(P>0.05)。结论 PDA是肺血减少型CHD的重要供血通道,在体-肺分流术或Glenn手术时应予以保留,以利于肺动脉的进一步发育和二期根治手术实施。
Objective To analyze the effect and clinical significance of patent ductus arteriosus on the pulmonary vascular development of congenital heart defect (CHD) in the lungs. Methods Eighteen children with CHD with pulmonary arterial atresia were included in this study. Among them, 10 cases had pulmonary atresia and 8 cases had pulmonary stenosis. According to whether they had patent ductus arteriosus (PDA), they were divided into 2 groups, 10 cases (pulmonary atresia 9, pulmonary artery 1 patient with stenosis) were PDA group, 8 patients (1 pulmonary atresia and 7 pulmonary stenosis) were non-PDA group. The general condition of the two groups and pathological changes of lung tissue were observed. Morphometric semi-quantitative method was used to measure the percentage of media thickness (MT%), the percentage of media section area MS%, numbers of vascular per square centimeter (VPSC) and mean alveolar munber (MAN). Results There was no significant difference in age, percutaneous oxygen saturation, hematocrit, hemoglobin, thoracic and cardiac rate, pulmonary artery index between the two groups (P> 0.05). The lumen of pulmonary arterioles in both groups were tortuous and dilated, The changes of varicose veins, thinning of the elastic tissue layer in the wall, or the formation of small arteriovenous fistula in the lung were observed. The percentages of MT% [(15.4 ± 6.3)%], MS% [(0.2 ± 0.1)%], VPSC [ (15.3 ± 5.6)%, (0.2 ± 0.1)%, (1.8 ± 0.5) / mm2, (63.1 ± 0.9) / mm2, MAN [65.3 ± 22.7] / mm2] 17.3) / mm2], there was no significant difference (P> 0.05). Conclusion PDA is an important blood supply channel of pulmonary blood reduced CHD. It should be reserved during body-lung shunt or Glenn surgery to facilitate the further development of pulmonary artery and the implementation of second-stage radical operation.