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目的:通过对200例先天性心脏病(CHD)患儿心脏病手术前慢性充血性心力衰竭(CHF)及肺动脉高压(PH)的研究,探讨CHD患儿术前的CHF、PH发生率,诊断方法及干预。方法:通过改良Ross心力衰竭评分,血浆氨基末端脑利钠肽前体(NT-proBNP)、内皮素-1(ET-1)、心肌肌钙蛋白Ⅰ(cTnⅠ)检测,超声心动图PH测定,对CHF、PH做出综合评定并计算其发生率。对术前CHF、PH患儿提出干预建议。结果:CHD术前CHF、PH的发生率分别为17.5%(35例)和11.5%(23例)。CHF组与对照组Ross心力衰竭评分、NT-proBNP、cTnⅠ比较差异均有统计学意义(P<0.05);PH组与对照组NT-proBNP比较差异有统计学意义(P<0.05),PH组与对照组cTnⅠ比较差异无统计学意义(P>0.05)。CHF组及PH组ET-1均无1例异常升高。结论:改良Ross心力衰竭评分,超声心动图PH测定及NT-proBNP、cTnⅠ检测对CHD术前CHF及PH可做出准确的判断。术前CHF、PH患儿进行相应的干预对提高日后手术成功率及患儿的生存质量具有积极的意义。
Objective: To investigate the preoperative incidence of CHF and PH in children with CHD and the diagnosis of chronic heart failure (CHF) and pulmonary hypertension (PH) in 200 children with congenital heart disease (CHD) Methods and interventions. Methods: By improving the Ross heart failure score, the levels of plasma NT-proBNP, ET-1, cTnⅠ, echocardiography PH, The CHF, PH make a comprehensive assessment and calculate the incidence. Preoperative CHF, PH children make intervention recommendations. Results: The incidence of CHF and PH before CHD were 17.5% (35 cases) and 11.5% (23 cases) respectively. There was significant difference between CHF group and control group in Ross heart failure score, NT-proBNP and cTnⅠ (P <0.05), and there was significant difference in NT-proBNP between PH group and control group (P <0.05) Compared with the control group cTn Ⅰ no significant difference (P> 0.05). There was no abnormal increase of ET-1 in CHF group and PH group. Conclusion: The improved Ross heart failure score, PH echocardiography and NT-proBNP, cTn Ⅰ detection of CHD preoperative CHF and PH can make accurate judgments. Preoperative CHF, PH in children with the corresponding intervention to improve the success rate of surgery and children with a positive quality of life.