论文部分内容阅读
目的:探讨高原地区藏族房间隔缺损(ASD)合并肺动脉高压(PAH)患者介入封堵术后心脏结构及肺动脉收缩压(PASP)的变化,并与汉族患者进行比较。方法:106例接受介入封堵治疗的ASD-PAH患者(年龄≥18岁)根据民族分为藏族组(41例)和汉族组(65例),分别在术前、术后3d、术后3个月进行经胸超声心动图(TTE)检查,比较两组PASP及心脏结构的改变。结果:术前藏族患者主肺动脉内径(MPAD)大于汉族患者(P<0.05),PASP低于汉族患者(P<0.05)。术后3d两组患者MPAD均较术前缩小,PASP降低(P<0.05),且藏族PASP的下降程度优于汉族(P<0.05),这种优势持续到术后3个月。术后3d两组患者右房、右室内径均较术前缩小,左室舒张末内径增大(P<0.05);术后3个月藏族患者右房、右室内径进一步缩小(P<0.05),而左室舒张末内径在两组患者中均较术后3d进一步增大(P<0.05)。结论:高原地区藏族成人ASD-PAH患者介入封堵治疗纠正缺损畸形可有效缓解PAH,改善心脏结构,其短期疗效优于汉族患者,可能与世居藏族的遗传优势及高原适应性有关。
Objective: To investigate the changes of heart structure and pulmonary artery systolic pressure (PASP) after interventional occlusion in Tibetan atrial septal defect (ASD) patients with pulmonary hypertension (PAH) in the plateau and to compare with those of Han patients. Methods: A total of 106 ASD-PAH patients (aged 18 years or older) undergoing interventional blockage were divided into Tibetan group (41 cases) and Han nationality group (65 cases) according to nationality. Preoperative and postoperative 3d, postoperative 3 Transthoracic echocardiography (TTE) was performed for months to compare the changes of PASP and cardiac structure in both groups. Results: Preoperative anterior major pulmonary artery diameter (MPAD) was significantly higher in Han patients (P <0.05) and PASP was lower in Han patients (P <0.05). After 3 days, the MPAD of both groups decreased, PASP decreased (P <0.05), and the decline of Tibetan PASP was better than that of Han (P <0.05). This advantage lasted for 3 months. The right atrium and the right ventricle diameter of the two groups were both decreased and the left ventricular end-diastolic diameter was increased (P <0.05) 3d after operation. The right atrium and the right ventricle diameter of Tibetan patients were further reduced 3 months after operation (P <0.05 ), While the left ventricular end-diastolic diameter increased in both groups (P <0.05) compared with that of the control group after 3d. Conclusion: Interventional occlusion of Tibetan adult ASD-PAH patients in high altitude area can effectively alleviate PAH and improve cardiac structure. Its short-term curative effect is better than that of Han patients, which may be related to the genetic predominance and plateau adaptability of Tibetan natives.