超声心动图定量测量先天性心脏病肺动脉高压全肺阻力的方法学研究  

Methodology of Echocardiographic Quantitative Measurement of Total Pulmonary Resistance in Congenital Heart Disease with Pulmonary Hypertension

作　　者：逄坤静[1] 王浩[1] 

机构地区：[1]阜外心血管病医院超声科,北京市100037

出　　处：《中国超声医学杂志》2007年第5期394-396,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探索超声心动图定量测量先天性心脏病(CHD)肺动脉高压患者全肺阻力(TPR)的方法,实现无创评价肺动脉高压(PH)。方法选择先天性心脏病室间隔缺损(VSD)及动脉导管未闭(PDA)合并PH的患者15例。通过测量肺动脉瓣最大反流压差(PPR),加上右房压(PRA)得到肺动脉平均压(PAMP);PRA根据下腔静脉内径估测。测量收缩期肺动脉瓣环内径(PVD)计算出肺动脉瓣瓣口面积(PVA)。利用脉冲多普勒测量肺动脉瓣口血流流速时间积分(PVVTI)。按照公式肺循环血流量(QP)=PVA×PVVTI×HR(心率)计算QP。根据TPR=PAMP/QP×BSA(体表面积)公式,即可计算出TPR。同样方法测量主动脉瓣口通过的血流量可得到体循环血流量(QS),进而可计算出肺、体循环血流量比值(QP/QS)。对于PDA患者,由于动脉水平分流,而使主动脉口通过的血流量相当于肺循环血流量,肺动脉口通过的血流量相当于体循环血流量。全部患者超声检查完毕后3d内完成右心导管检查。对2种测量结果进行了对比。结果2种方法所测量的结果高度相关,超声心动图能够较为准确地测量肺高压患者的TPR、QP/QS等右心导管所能测量的参数,进而定量诊断PH。结论利用超声心动图通过测量肺动脉压力及肺循环血流量,从而获得TPR及QP、QS等"右心导管参数",作为无创右心导管检查技术有着潜在的应用前景。Objective To explore the possibility and reliability of total pulmonary resistance （TPR） measured by ultrasound in congenital heart disease （CHD） patients with pulmonary hypertension （PH）. Methods Fifteen patients with congenital ventricular septal defect （VSD） or patent ductus arteriosus （PDA） with different PH levels were included in this study. The highest pressure gradient of pulmonary valvular regurgitation（PPR） was measured with Doppler. The pulmonary artery mean pressure （PAMP） was calculated by adding PPR to the pressure of right atrium（PRA） which could be estimated through the diameter of inferior venous cava（IVC）. The pulmonary valvular area （PVA） was calculated by measuring the diameter of pulmonary valvular annulus. The pulmonary valvular velocity time integral （PVVTI） was obtained from the pulsed wave Doppler. The quantity of pulmonary blood flow （QP） could be calculated with the equation of QP = PVA × PVVTI × HR, where HR represented heart rate. Therefore,TPR could be obtained by the equation of TPR = PAMP/QP × BSA,where BSA represented body surface area. The same method was applied to the measurement of the blood passing through the aortic valve（QS）, and the ratio of QP and QS（QP/QS） could be calculated. With the equation of TPR=PAMP/QP × BSA（TPR,total pulmonary resistance）,TPR could be reached as a result,as well as the ratio of pulmonary and systemic blood flow QP/QS. For the patients with PDA,as a special haemodynamic model,the shunt between two arteries would cause the blood flow through aortic valve,which is about esual to that of QP,while the blood flow through pulmonic valve is about equal to that of QS. The examination of right cardiac catheter on all patients was completed within three days after echocardiographic examination. Catheter and echocardiographic results were compared. Results There was a high correlation between the data measured by these two methods. The parameters obtained by echocardiography, such as TPR and QS/

关 键 词：先心病 肺动脉高压 全肺阻力 超声心动图 

分 类 号：R541.1[医药卫生—心血管疾病]