Page 139 - 先天性心脏病的导管术：从婴幼儿期到成人期

11 Hemodynamic Assessment: Pressures, Flow, Resistances…
175
11.7 Pulmonary Vascular Reactivity Testing
The assessment of pulmonary vascular reactivity plays an impor-
tant role in the management and assessment of pulmonary hyper-
tension. Following baseline hemodynamic assessment, the patient
is exposed to 100% oxygen (for a minimum of 10 min) and repeat
saturations and pressure measurements. When enriched oxygen is
administered (F I O 2 > 30%), the dissolved oxygen must be
accounted for in the calculation. Failure to do so will underesti-
mate of PVR. Situations that can increase PVR include hypoxia,
hypercapnia, erythrocytosis, increased sympathetic tone pulmo-
nary emboli, precapillary pulmonary edema, lung compression
(pleural effusion), mechanical ventilation, and positive intratho-
11 血液动力学评估：压力，流速，阻力和血管反应性实验 121
racic pressure. Common errors in PVR assessment include
hypoventilation and acidosis producing pulmonary vasoconstric-
tion, failure to calculate dissolved O 2 , and underestimate AV O 2
评估中的常见错误包括通气不足和酸中毒，导致肺血管收缩，无法计算溶解的 O 2 ，低
difference which overestimates pulmonary blood flow and under-
估了 AV O 2 差异，这高估了肺血流量并低估了 PVR，并且在间隔缺损的情况下，假设
estimates PVR, and in the setting of a septal defect assuming that
no fall in PAP means no fall in PVR.
PAP 没有下降意味着 PVR 没有下降。
For example, a child with a VSD, Hgb = 100 g/l and
2
例如，具有 VSD 的儿童，Hgb = 100 g/L 和 VO 2 = 150 mL/min/m 。在室内空气
VO 2 = 150 ml/min/m . In room air, Ao sat = 95%, PA sat = 80%,
2
mLA p = 6 mmHg, and mPAP = 60 mmHg.
中，Ao sat = 95%，PA sat = 80%，mLA p = 6 mmHg，mPAP = 60 mmHg。Q p ∶ Q s 将是
The Q p :Q s will be 95–72.5/95–80 = 1.5:1.
The PVRI in room air will be calculated first by calculating the
95−72.5/95−80 = 1.5 ∶ 1。
oxygen capacity as
首先通过计算氧气容量来计算室内空气中的 PVRI：

Oxygen capacity Hgbg l / . 139 100 139 mlO / l

2
Oxygen content for the PA and PV can then be calculated as
PA 139 80% % 111 2. ml O / l
2

PV 139 95% % 132 05. ml O / l
2
And the pulmonary AV O 2 difference:
PV PA 132 05. 111 20. 20 85. mlO / l
2
2
2
肺血流量将是 VO 2 差 = 150 mL/min/m /20.85 mL O 2 / 肺 AV O 2 /L = 7.19 L/min/m 。
2
PVRI 将是 60 – 8/7.19 = 7.23 伍德单位·m 。
现在给孩子 100% 氧气呼吸，测量值为 mPAP = 60 mmHg，mLA p = 8 mmHg，PA
sat 为 95%，PaO 2 为 95 mmHg，Ao sat 为 600 mmHg 的 PaO 2 100%。现在，如果不考
2
虑溶解氧，则 A-VO 2 差异将是 6.95 mL O 2 /L，肺血流量 21.53 L/min/m ，PVRI 2.4 伍
德单位·m 。当考虑溶解氧时（应如此），A-VO 2 差为 22.1 mL O 2 /L，肺血流量为 6.78
2
2
2
L/min/m 。PVRI 则为 7.66 伍德单位·m ，不显示血管反应性。除了氧气激发外，研
究还可以包括一氧化氮（通常为 40 ppm）和口服西地那非。在这种情况下，应允许在
药物之间进行洗脱，并在下一次药物挑战之前返回基线进行测量。

参考文献

[1] Li J. Accurate measurement of oxygen consumption in children undergoing cardiac
catheterization. Catheter Cardiovasc Interv. 2013;81(1): 125-32.
[2] Wilkinson JL. Haemodynamic calculations in the catheter laboratory. Heart.
2001;85(1):113-20.

[3] LaFarge CG, Miettinen OS. The estimation of oxygen consumption. Cardiovasc Res.