呼吸对慢性阻塞性肺疾病心脏血流动力学影响的超声心动图研究  

Echocardiographic study on the effects of respiratory on cardiac hemodynamics in chronic obstructive pulmonary disease

作　　者：杨瑞静[1] 曹铁生[1] 袁丽君[1] 王泓[2] 段云友[1] 贾化平[1] 

机构地区：[1]第四军医大学唐都医院超声诊断科,西安710038 [2]南京军区总医院超声诊断科

出　　处：《中华超声影像学杂志》2006年第4期277-280,共4页Chinese Journal of Ultrasonography

摘　　要：目的用超声心动图方法检测慢性阻塞性肺疾病(COPD)患者自然呼吸过程中心脏各瓣口血流速度随呼吸的变化,探讨自然呼吸对COPD患者心功能影响的机制及临床意义。方法采用AcusonSequoia512彩色超声仪记录20例COPD患者和30例健康人自然呼吸时心脏各瓣口血流速度,同步记录心电图和呼吸曲线,计算各瓣口的血流速度呼吸性波动指数(RVI)。结果COPD组与健康对照组均表现为二尖瓣E峰血流速度和主动脉瓣血流速度在呼气相高于吸气相(P<0.001),三尖瓣E峰血流速度和肺动脉瓣血流速度在吸气相高于呼气相(P<0.001)。COPD组心脏各瓣口血流速度RVI较对照组均明显增大[二尖瓣(16.26±8.71)%对(10.53±3.15)%,P<0.03;主动脉瓣(11.61±4.96)%对(4.67±1.79)%,P<0.001;三尖瓣(27.74±8.39)%对(14.89±6.32)%,P<0.001;肺动脉瓣(13.78±4.98)%对(8.55±2.32)%,P<0.001]。结论COPD组与健康对照组自然呼吸时心脏各瓣口血流速度随呼吸时相波动的变化规律一致,但COPD组四个瓣口RVI较健康对照组明显升高,进一步证明了呼吸性胸压变化可以导致心脏各瓣口血流速度变化。该结果对COPD患者肺实质损伤程度的判定以及治疗效果的追踪观察有重要参考价值。Objective To study the velocity variation of four cardiac valves during natural respiration to research the mechanism and clinical importance of natural respiration on cardiac function in the patients with chronic obstructive pulmonary disease（COPD）. Methods Pulsed-wave Doppler spectra of all four cardiac valves were recorded by Acuson Sequoia 512 in 20 COPD patients and 30 normal control subjects. Electrocardiogram and respiratory tracing by a nasal thermistor were recorded simultaneously. And then the respiratory variation indices （RVI） of the four cardiac valves were calculated. Results During natural inspiration, the peak E velocity of mitral valve and the velocity of aortic valve significantly decreased（ P 〈 0. 001）. On the contrary,the peak flow velocity across the pulmonary valve and E flow velocity across the tricuspid valve increased during inspiration（ P 〈0. 001）. The RVI of the four cardiac valves in COPD group were significantly higher than that in normal subjects [mitral valve： （16.26 ±8.71）% vs （10.53± 3.15）%, P G0.03; aortic valve： （11.61 ± 4.96）% vs （4.67 ± 1.79）%, P G0.001; tricuspid valve： （27.74± 8.39）% vs （14.89 ±6.32）%, P 〈0.001; pulmonary valve： （13.78 ± 4.98）% vs （8.55 ± 2.32） %, P 〈0.001]. Conclusions The rules in velocity variation of the four cardiac valves during natural respiration in COPD group and normal subjects were identical, but the RVI of four cardiac valves in COPD group was significantly higher than that in normal group. This further proved that the respiratory intrathoracic pressure change is one of the reasons that induce the respiratory changes of velocity across cardiac valve. These results have favorable reference values in differentiating of the severity of pulmonary parenchyma trauma and the follow up of the curative effects.

关 键 词：超声心动描记术 多普勒 肺疾病 慢性阻塞性 呼吸 血流速度 

分 类 号：R445.1[医药卫生—影像医学与核医学]