心脏超声评估肺动脉高压患者肺血管压力及右心功能的临床价值

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摘要目的: 探究心脏超声在评估肺动脉高压（pulmonary arterial hypertension， PAH）患者肺血管压力及右心功能中的临床价值。方法: 回顾性分析疑似右心功能障碍的PAH患者97例（研究组）的临床资料，另选取同期健康体检者32例作为对照组； PAH患者根据肺动脉收缩压（PASP）分为轻度组（n=45）、中度组（n=32）与重度组（n=20），所有研究对象均心脏超声检查。对比研究组与对照组肺动脉直径指标主肺动脉直径（DPA）、右肺动脉直径（RPAD），肺动脉血压指标PASP、肺动脉舒张压（PADP）、肺动脉压平均值（PAPM），右心功能指标右心室射血分数（RVEF）、右心室面积变化率（RVFAC）、三尖瓣环收缩期移位（TAPSE）、三尖瓣环侧壁收缩期运动速度（s）、三尖瓣舒张期血流E峰和A峰比值（E/A值）、右室心肌做功指数（RMPI），并分析右心功能各指标与PASP的相关性。结果：研究组PAH患者DPA、RPAD、PASP、PADP、PAPM、E/A值、RMPI明显高于对照组，RVEF、RVFAC、TAPSE、s明显低于对照组（P<0.05）；轻度组、中度组和重度组的DPA、RPAD、PASP、PADP、PAPM、E/A值、RMPI等指标逐渐升高，RVEF、RVFAC、TAPSE、s等逐渐降低，差异均有统计学意义（P<0.05）；RVEF、RVFAC、TAPSE、s与PASP均呈明显负相关（P<0.001），E/A值、RMPI与PASP均呈明显正相关（P<0.001）。结论：心脏超声检查可准确、客观地对PAH患者的肺血管压力及右心室功能作出评估，为临床诊疗提供可靠参考。

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	张进1
	冯健2

关键词 ：肺动脉高压, 心脏超声, 肺血管压力, 右心功能

Abstract：Objective: To evaluate the clinical value of cardiac ultrasonography in evaluating pulmonary vascular pressure and right heart function in patients with pulmonary arterial hypertension (PAH). Methods: A retrospective analysis was performed with the clinical data of 97 PAH patients suspected of right heart dysfunction(study group). Another 32 healthy people who underwent physical examination during the same period were selected as the control group. According to pulmonary artery systolic pressure (PASP) of PAH patients, they were divided into mild group (n=45), moderate group (n=32) and severe group (n=20). All study subjects underwent cardiac ultrasonography. The pulmonary artery diameter indexes ［pulmonary arterydiameter (DPA), right pulmonary artery diameter (RPAD)］, pulmonary artery blood pressure indexes ［PASP, pulmonary artery diastolic pressure (PADP), mean pulmonary artery pressure (PAPM)］ and right heart function indexes \[right ventricular ejection fraction (RVEF), right ventricular fractional area change rate (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annulus sidewall systolic velocity (s), ratio of tricuspid valve diastolic peak E and peak A (E/A value), right ventricular myocardial performance index (RMPI)\] were compared between the study group and control group, and the correlation between right heart function indexes and PASP was analyzed. Results: The DPA, RPAD, PASP, PADP, PAPM, E/A value and RMPI of PAH patients in the study group were significantly higher than those in the control group， while the RVEF, RVFAC, TAPSE and s were significantly lower than those in the control group (P<0.05). The DPA, RPAD, PASP, PADP, PAPM, E/A value and RMPI in the mild group, moderate group and severe group were gradually increased， while the RVEF, RVFAC, TAPSE and s were gradually decreased (P<0.05). RVEF, RVFAC, TAPSE and s were significantly negatively correlated with PASP (P<0.001), and E/A value and RMPI were significantly positively correlated with PASP (P<0.001). Conclusion: Cardiac ultrasonography could accurately and objectively assess the pulmonary vascular pressure and right ventricular function in patients with PAH, and provide a reliable reference for clinical diagnosis and treatment.

收稿日期: 2020-09-28

通讯作者: 冯健（通讯作者），副主任医师，E-mail：13851128059@163.com

作者简介: 张进（1981—），女，副主任医师

引用本文:

张进1，冯健2. 心脏超声评估肺动脉高压患者肺血管压力及右心功能的临床价值[J]. 江苏大学学报:医学版, 2021, 31(01): 69-72. ZHANG Jin1， FENG Jian2.

Clinical value of cardiac ultrasonography in evaluating pulmonary vascular pressure and right heart function in patients with pulmonary arterial hypertension

. Journal of Jiangsu University(Medicine Edition), 2021, 31(01): 69-72.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2021/V31/I01/69

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