超声心动图评价特发性肺动脉高压病右心功能研究  

Evaluation of Right Ventricular Function in Patients with Idiopathic Pulmonary Arterial Hypertension by Echocardiography

作　　者：浦江[1] 徐黎莎[1] 王建平[1] 黄娟[1] 施林妹[1] 

机构地区：[1]同济大学附属上海市肺科医院超声科,上海市200433

出　　处：《中国超声医学杂志》2011年第5期429-432,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的评价二维彩色多普勒超声心动图(2DCDE)在特发性肺动脉高压(IPAH)病患者的右心功能检测中的价值。方法运用2DCDE检测27例IPAH患者二维图像上右室舒张末期横径(RVDD)、右室游离壁舒张末期厚度(RVDw)、主肺动脉内径(MPA)、右室舒张末期面积(RVEDA)和右室收缩末期面积(RVESA)并计算右室面积变化率(RVFCA);M型超声测量三尖瓣环收缩期位移(TAPSE);脉冲多普勒测量三尖瓣下舒张期血流充盈值E、A并计算E/A比值;通过三尖瓣上反流峰值估测肺动脉收缩压(SPAP);组织多普勒法测量三尖瓣环游离壁右室肌收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)以及右室肌等容收缩、舒张时间(ICT和IRT)和射血时间(ET),计算心肌运动指数(MPI)。所有测值与30例正常人各项超声指标对比分析。结果与正常对照组比较:(1)IPAH患者的RVDD和RVDW明显增大,而RVPCA和TAPSE降低。(2)IPAH患者三尖瓣下血流峰值流速E/A比值下降,SPAP显著增高。(3)IPAH患者右室肌舒张期心肌运动速度Em/Am比值降低,右室肌等容时间(ICT+IET)延长,ET缩短,MPI增加。两组各项超声指标差异显著(P<0.01)。结论 2DCDE技术能较准确地对IPAH患者的右心结构和功能变化进行评价。Objective To evaluate the value of two-dimensional color Doppler echocardiography （2DCDE） in testing the right heart function of patients with idiopathic pulmonary arterial hypertension （IPAH）. Methods 27 cases with IPAH were studied. Right ventricular end-diastolic diameter （RVDD）, right ventricular free wall end-diastolic thickness （RVDW）, the main pulmonary artery （MPA）, right ventricular end-diastolic area （RVEDA） and right ventricular end-systolic area （RVESA） were measured using 2DCDE, and right ventricular fractional area change （RVF- CA） was calculated; Tricuspid annular plane systolic excursion （TAPSE） was measured by M-mode ultrasound; The diastolic blood flow filling value E.A of tricuspid was measured by pulsed Doppler, and the E/A ratio was calculated; Systolic pulmonary artery pressure （SPAP） was estimated through peak value of the tricuspid reflux; Right ventricular wall peak systolic velocity （Sin） .peak early diastolic velocity （Em）, peak late diastolic velocity （Am） of right ventric- ular muscle in tricuspid annulus free wall .isovolumetric contraction time. Isovolumic relaxation time （ICT/IRT）, and ejection time （ET） of right ventricular muscle were measured by tissue Doppler, the myocardial motion index （MPI） was calculated as well. All values were analyzed in contrast with those of 30 normal subjects. Results Compared with the control： （1） RVDD and RVDW of the patients with IPAH significantly increased, while RVFCA and TAPSE de- creased; （2） The blood flow peak velocity E/A ratio under tricuspid valve in patients with IPAH decreased, while SPAP increased significantly. （3） Right ventricular diastolic myocardial velocity Em/Am ratio in patients with IPAH decreased, right ventricular muscle isovolumic time （ICT＋ IRT） increased, ET reduced and MPI increased. There were significant differences in two groups （P〈0.01）. Conclusions 2DCDE technology can evaluate right ventricular structure and function change of

关 键 词：超声心动图 特发性肺动脉高压 右心功能 

分 类 号：R540.45[医药卫生—心血管疾病] R544.16[医药卫生—内科学]