| 摘要: |
| 目的：旨在从我院先天性心脏病（CHD）并发肺动脉高压（PAH）的住院构成及临床表现，了解CHD住院患者合并PAH的患病情况。方法：回顾性分析2001年1月至2007年7月间我院收治的3 674例CHD患者中确诊PAH的238例患者。结果：近6年我院CHD住院患者3 674例中并发PAH 238例(6.48%),包括房间隔缺损（ASD）中的10.8%、室间隔缺损（VSD）中的2.81%、动脉导导管未闭（PDA）中的5.57%及其他复杂类型中的19.6%。平均年龄(45.6±17.7)岁,(40～60)岁占49.6%，女性165例（69.3%），主要构成比依次为：ASD(62.6%)、VSD(19.7%)、 PDA(13.4%)。其中VSD、PDA及其他复杂畸形患者均较ASD年轻（P<0.01），ASD中女性占优势，与VSD相比有差异（76.5% vs 44.7%,P<0.01）。所有病例最常见的表现是活动后胸闷、气急起病，查体见P2亢进，胸片示心影增大及肺动脉干突出，心电图示不完全右束支传导阻滞及右室肥大,超声心动图提示右心系统增大、主肺动脉内径增宽。超声估测肺动脉收缩压与导管测压相关性有统计学意义(r=0.734，P<0.01)。结论：CHD住院患者中PAH是常见的并发症，以女性、ASD、40~60岁年龄组为主。临床表现、胸片、心电图检查多无特异性，超声心动图对诊断有重要意义，且估测肺动脉收缩压值与导管测压相关性好。 |
| 关键词: 先天性心脏缺损 肺性高血压 流行病学 住院 诊断 |
| DOI：10.3724/SP.J.1008.2008.00306 |
| 投稿时间：2007-11-18修订日期：2008-01-30 |
| 基金项目: |
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| Inpatients with congenital heart disease complicated with pulmonary arterial hypertension: an analysis of patient composition and clinical features |
| GUO Yan,QIN Yong-wen* |
| (Department of Cardiology, Changhai Hospital，Second Military Medical University，Shanghai 200433， China) |
| Abstract: |
| Objective：To investigate the composition and clinical features of inpatients with congenital heart disease (CHD) complicated with pulmonary arterial hypertension (PAH) from a cardiovascular department.Methods: We retrospectively analyzed the clinical data of 238 PAH patients who were identified from 3 674 CHD inpatients in Changhai Hospital during Jan, 2001 to Jul, 2007.Results: Among the 3 674 CHD inpatients who were treated in our hospital in recent 6 years, 238 (6.48%) had PAH.PAH was found in 10.8% of patients with atrial septal defect (ASD), 2.81% of patients with ventricular septal defects (VSD), 5.57% of patients with patent ductus arteriosus (PDA), and 19.6% of patients with complex types.The mean age of patients was (45.6±17.7) years, with 49.6% of them being 40-60 years.Female patients accounted for 69.3% of the total.The composition of PAH patients was: ASD (62.6%), VSD(19.7%), and PDA(13.4%).The patients with VSD,PDA or other complex types were younger than those with ASD（P<0.01）.More female PAH patients had ASD than VSD （76.5% vs 44.7%,P<0.01）.Most patients had chest distress and dyspnea on exertion as initial symptoms and accentuated pulmonary component of the second heart sound as physical sign; they also had increased cardiothoracic ratio, prominent, dilated central pulmonary arteries on chest radiography, right ventricle enlargement, and incomplete right bundle branch block on ECG.The pulmonary artery systolic pressure(sPAP), as estimated by echocardiography, had a significant correlation with catheterization measurements(r=0.734，P<0.01).Conclusion: PAH is common in patients with CHD, especially in females, those with ASD, and those of 40-60 years old.The clinical presentation, chest radiography and ECG are normal.Echocardiography has important diagnosis value.There is a correlation between echocardiography and catheterization measurements of sPAP. |
| Key words: congenital heart defects pulmonary hypertension epidemiology hospitalization diagnosis |
