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“胎盘血管阻力的新型评分方法”点评
BackgroundUmbilical artery Doppler veloci-metry is a routine method for fetal surveillance in high-risk pregnancy．Uterine artery Doppler seems to give comparable information，but it can be diffi-cult to interpret as there are two arteries，which might show notching and／or increased pulsatility index （PI）as signs of increased vascular imped-ance．Combining the information on vascular re-sistance on both sides in a new score might simplify and improve evaluation of placental circulation．MethodsUterine and umbilical artery Doppler velocimetry was evaluated in 633 highrisk pregnan-cies．The managing clinician was informed only a-bout the umbilical artery flow．The umbilical ar-tery flow spectrum was semiquantitatively divided into four blood flow classes （BFC ），expressing signs of increasing vascular resistance．The uterine artery Doppler flow spectrum was divided into five uterine artery scores （UAS），taking into account presence／absence of notching and／or increase in PI．By adding UAS to BFC，a new placental score （PLS）was constructed with values ranging from 0 to 7，indicating general placental vascular resistance．The scores were related to three outcome variables：small-for-gestational age （SGA），premature delivery （＜37 weeks），and cesarean section．ResultsAll three score systems showed a significant relationship between signs of increasing vascular resistance and outcome．The new PLS showed the best association to adverse outcomes， with optimal cut-off at values exceeding score 3．ConclusionDoppler velocimetry on both sides of the placenta showed a strong relationship to an adverse outcome of pregnancy． The new PLS showed a better relationship to adverse perinatal outcome than the BFC and the UAS．The PLS can simplify evaluation of uteroplacental and fetopla-cental Doppler velocimetry．
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儿童肺动脉高压的研究现状与未来
肺高压( pulmonary hypertension,PH)指肺循环压力超出正常,可由多种心、肺等疾病引起,严重者可导致右心室负荷增大、右心功能不全,引起一系列临床表现.肺动脉高压(pulmonary arterial hypertension,PAH)是指肺动脉压力和阻力增加,是PH的一种类型[1].当今广泛采用的PAH血流动力学定义为:在海平面静息状态下,右心导管测定肺动脉平均压(mPAP)高于25 mm Hg(1 mm Hg=0.133 kPa),肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)低于或等于15 mm Hg或肺血管阻力(pulmonary vascular resistance,PVR)大于3 Wood单位[1-2].来自法国的一项注册研究显示,PAH的患病率为15/百万[3],其中儿童患病率为3.7/百万[4].目前我国尚无儿童PAH的流行病学数据,儿童PAH注册登记研究尚待开展.
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小儿先天性心脏病相关性肺高压诊断和治疗(专家共识)
前言肺高压(pulmonary hypertension,PH)是指在海平面安静呼吸时由右心导管检查测得的肺动脉平均压(mean pulmonary arterial pressure,mPAP)≥25 mmHg.肺动脉高压(pulmonary arterial hypertension,PAH)是指孤立的肺动脉压力增高,而肺静脉压力正常,主要原因是肺小动脉原发病变或其他的相关疾病导致肺血管阻力(pulmonary vascular resistance,PVR)增高,表现为肺动脉压力升高而肺静脉压力正常,诊断标准是在PH的基础上同时伴有肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)＜15 mmHg,跨肺压(transpulmonary gradient,TPG)＞12 mmHg.
