心功能综合指数与脑钠肽对诊断肺动脉缩窄所致急性右心衰竭的作用  

Diagnostic value of Tei index and brain natriuretic peptide in acute right heart failure induced by constricting pulmonary artery

作　　者：张栋[1] 庞宝森[1] 吴雅峰[1] 杨媛华[1] 肖绍玲[2] 王辰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院、北京市呼吸疾病研究所,北京100020 [2]山西省长治医学院附属和平医院呼吸科

出　　处：《中华急诊医学杂志》2007年第3期246-250,共5页Chinese Journal of Emergency Medicine

基　　金：国家“十五”科技攻关资助项目（201MBA703807）

摘　　要：目的探讨心功能综合指数（Tei指数）、脑钠肽（BNP）在诊断肺动脉缩窄所致急性右心衰竭中的作用。方法选取24只健康成年杂种犬，随机分为肺动脉缩窄20％、40％和假手术三组，通过缩窄犬肺动脉建立后负荷加重急性右心衰竭模型。同步重复测定各组肺动脉缩窄后0、1、2、3、4h的血流动力学指标和超声指标，并进行相关性比较。用酶联免疫分析方法测定0、1、2、3、4h的血清BNP含量。结果与假手术组相同时间点比较，肺动脉缩窄40％组4h时＋dpldf～、一dpldt一显著低于假手术组[（358．8±42．7）mmHg／s vs（690±14．5）mmHg／s，（351±55．4）mmHg／s vs（542±13．8）mmHg／s]（P〈0．05）；Tei指数显著高于假手术组[（1．20±0．39）vs（0．58±0．13）]（P〈0．05）。Tei指数与＋dp/dtmax和-dp/dtmax呈负相关（r=-0．49，P〈0．05vs r=-0．46，P〈0．05）。肺动脉缩窄40％组右室压力负荷增高时，血清脑钠肽在1h轻度升高，4h升高更为明显，BNP与＋dp／dfmax和-dp/dtmax呈负相关（r=-0．48，P〈0．05vs r=-0．56，P〈0．05）。结论缩窄成年杂种犬肺动脉40％可以成功建立急性右心衰竭模型。Tei指数和脑钠肽与右心功能不全具有相关性，两者对于诊断右心衰竭具有一定的临床意义。Objective To investigate diagnostic value of cardiac function index （Tei index） and brain natriuretic peptide in acute right heart failure induced by constricting pulmonary artery. Method Twenty - four health hybrid canines were randomly divided into three groups： 20% pulmonary artery constriction, 40% pulmonary artery constriction and the sham group. Invasive hemodynamic indexes and echocardiography indexes were measured synchronously at 0, 1, 2, 3, 4 hours after constricting the pulmonary artery, and correlation of these indexes was analyzed. The plasma BNP levels at the different phases and degree of constriction were measured by Elisa method. Results At 4 hours, ＋ dp/dtmax and- dp/dtmax in 40% pulmonary artery constriction were lower than those in the sham group [ （358.8 ± 42.7 ） mmHg/s vs （690 ± 14.5） mmHg/s, （351 ± 55.4） mmHg/s vs （542 ± 13.8） mmHg/s], （ P 〈 0.05）, and Tei index was much higher than that of the sham group [ （ 1.20 ± 0.39） vs （0.58 ± 0.13 ） ] （ P 〈 0.05）, and the negative correlation between Tei index and ＋dp/dtmax, - dp/dtmax= was r = - 0.49 （P 〈 0.05） and r = - 0.46 （P 〈 0.05）. In case of 40% pulmonary artery constriction, BNP increased at 1 hour, . and it was much higher than that in the sham group at 4 hours [ （5.93 ± 0.77 ） vs （1.22 ± 0.33） ng/ml] （ P 〈 0.05）, and the negative correlation between BNP and ＋ dp/dtmax, -dp/dtmax r= -0.48 （P〈0.05） and r= -0.56 （P〈0.05）. Conclusions The acute right ventricular dysfunction models could be successfidly made by constricting 40% of the circumference of the pulmonary artery. Tei index and BNP had good correlation with right ventricular function, and could be used for the diagnosis of the right ventricular dysfunction.

关 键 词：急性右心衰竭 TEI指数 脑钠肽 多普勒超声心电图 

分 类 号：R686[医药卫生—骨科学]