Pulmonary Mean Transit Times in Normal Children and in Those with Heart Diseases with Left-to-Right Shunts

小兒肺平均循環時間在正常及具左至右血液短絡心臓病兒的研究

呂鴻基(Hung-Chi Lue) ； 陳烱霖(Chiung-Lin Chen) ； 陳烱明(Chiung-Ming Chen)

《Acta Paediatrica Sinica》 11卷4期 (1970/12) Pp. 129-143

摘要

肺平均循環時間，即血液自主肺動脈瓣膜部流至左心房所需的平均時間。有關肺平均循環時間的研究不多，又僅限於動物及成人。至於有左至右血液短絡心臓病者，未見有報告。著者曾於成犬動物實驗，發現主肺動脈至體動脈，及左心房至體動脈兩個色素稀釋曲線的最高濃度時間的差值與平均循環時間的差值之間有極密切的相關。根據該相關式，則可由最高濃度時間差導出肺平均循環時間。著者應用此法於4例正常兒童及21例具左至右血液短絡心臓病兒，測得肺平均循環時間。4例正常兒童的平均爲4.30(±0.95)秒。21例具左至右血液短絡心臓病兒中，10例24個月以下嬰兒的平均爲2.06(±0.66)秒，11例24個月以上兒童的平均爲3.03(±1.0)秒。
依據相關性分析法，著者表現肺平均循環時間者，隨著肺血流量，心跳次數，肺對體動脈壓力比，及肺血管膨脹壓力的增加而縮短；髓著體重，身高，體面積的增加而增長；但不因肺血管抵抗，肺血管Compliance，或肺血量而有所變化。以肺血流量對肺平均循環時間的影響爲最大。在肺平均循環時間內的心跳次數，頗爲一定，平均焉5.7(±1.73)次。
本研究唆示肺平均循環時間的測定，有助於血管心臓造影術時，攝照次序的排定。肺平均循環時間的測定，可資以計測肺血量，對於左至右血液短絡所致的肺鬱血，以及肺血管阻塞病症等諸問題的解明，或有啓示性的貢獻。

並列摘要

Early since the original application of indicator dilution methods to determine the circulation time by Hering in 1829 measurement of the total (systemic plus pulmonary) circulation time has become a common diagnostic procedure useful for recognition and assessment of heart failure. Nevertheless, informations concerning the more specific circulation time, the pulmonary mean transit time (PMTT), are still not adequate. Most of the past studies on PMTT were limited to experimental animals and adults. To the best of our knowledge, no data on PMTT in he heart diseases with left- to-right shunts have ever been published in the literature.
The present study was designed to determine PMTT in normal children and in those with atrial septal defect, ventricular septal defect, patent ductus arteriosus or other congenital heart diseases with left-to-right shunts utilizing a new indicator dilution technique10. The relation of PMTT to the body weight, body height, body surface area and other hemodynamic factors were evaluated by means of regression analysis. Discussions on some special problems involved in the determination of the circulation time in infants and children were also made.