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高地での空洞肺パリアーションの性能:中期的な結果と失敗のリスク要因
Sunil P Malhotra1, D Dunbar Ivy, Max B Mitchell
1Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA. spmalhotramd@yahoo.com
Circulation
|October 10, 2008
まとめ
高地での生活は,空洞肺緩治療を受ける単一心室患者にとってリスクをもたらします. 潜在的不全の主要な指標には,肺動脈の高圧と肺横動脈の傾斜が含まれ,これらの患者では慎重にモニタリングする必要があります.
科学分野:
- ペディアトリック・カルディオロジー
- 生まれながらの心臓病 生まれながらの心臓病
- 手術による麻痺治療です.
背景:
- 単一心室の生理学では,穴肺連結などの複雑な外科的緩和が必要である.
- 高地での生活は,肺循環が血管抵抗に依存しているため,結果に影響を与える可能性があります.
- 高度特有の危険因子を特定することは,患者の管理を改善するために極めて重要です.
研究 の 目的:
- 高地に住む患者の穴肺緩和機能不全のリスク要因を特定する.
- 双方向的なグレン (BDG) とフォンタン手順の後の結果に対する高さの影響を評価する.
主な方法:
- 1995年から2007年の間にBDGを受けた,平均標高1600mに住む122人の患者の遡及的分析.
- 術前および術後の肺動脈圧 (PAP),肺経梯度 (TPG),肺血管インデックス抵抗 (PVRI) の評価.
- 生存の評価,緩和治療の失敗からの自由,および機能的状態 (ニューヨーク心臓協会のクラス).
主要な成果:
- BDGによる全生存率は5年後に92.4%で,緩和療法の失敗から81%自由であった.
- 緩和療法の失敗を経験した患者は,BDG前および後のPAPとTPGが有意に高かった.
- 高いBDG後のPVRIも,緩和障害 (P=0.007) と関連していました.
結論:
- 適度な高度にいるほとんどの患者は,BDGまたはFontan緩和で好ましい結果を経験します.
- PAP (>15 mm Hg),TPG (>8 mm Hg),PVRI (>2.5 木材U·m2) の上昇は,高度での緩和障害の重要な危険因子である.
- これらの発見は,より高い標高で暮らす単一心室患者の血液動力学的パラメータのモニタリングの重要性を強調しています.
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