超声心动图评价肺动脉血栓内膜剥脱术中远期疗效的临床研究  

Mid- and long-term follow-up study of improvement of right ventricular dysfunction after pulmonary endarterectomy with echocardiography

作　　者：李一丹[1] 吴雅峰[1] 吕秀章[1] 翟振国[3] 杨媛华[3] 顾松[2] 刘岩[2] 苏丕雄[2] 王辰[3] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏超声科,北京100020 [2]首都医科大学附属北京朝阳医院心外科,北京100020 [3]首都医科大学附属北京朝阳医院北京呼吸疾病研究所

出　　处：《中华超声影像学杂志》2014年第3期199-202,共4页Chinese Journal of Ultrasonography

基　　金：国家“十一五”科技支撑计划课题（2006BA101A06）;国家重点基础研究发展计划（973计划）（2009CB522107）

摘　　要：目的应用超声心动图监测肺动脉血栓内膜剥脱术（PEA）后血流动力学及右心功能改变情况，评价PEA中远期疗效。方法慢性血栓栓塞性肺动脉高压（CTEPH）患者32例，分别于PEA术前及术后3、12及24个月行经胸超声心动图检查。参数包括肺动脉收缩压（SPAP）、右室舒张末期面积（EDA）、收缩末期面积（ESA）、三尖瓣环收缩期位移（TAPSE）、组织多普勒右室心肌做功指数（MPI）及三尖瓣反流程度（GT1）。所有患者于PEA术前及术后3个月行右心导管检查测量肺血管阻力（PVR）及右心输出量（RC0）。结果PEA术后3个月SPAP明显下降，EDA、ESA及MPI减小，TAPSE升高，GT1减低（均P〈0．01）。PEA术后12及24个月随访显示患者右心功能进一步改善，其中有2例患者SPAP持续在50mmHg（1mmHg=0．133kPa）以上。MPI与PVR之间呈正相关（r=0．87，P〈0．001），MPI与RCO之间呈负相关（r=-0．77，P〈0．001）。结论超声心动图能够评价CTEPH患者PEA术治疗后右心功能及肺动脉压力改善情况。Objective To assess the ability of echocardiography to monitor the time course of right ventricular （RV） hemodynamic and functional improvement after pulmonary thromboendarterectomy （PEA）. Methods Thirty-two consecutive adult patients who underwent PEA for chronic thromboembolic pulmonary hypertension （CTEPH） were included in the study. Follow-up echocardiography was performed within 3,12, and 24 months of surgery. Systolic pulmonary artery pressure （SPAP）, end-diastolic right ventricular areas （EDA）, end-systolic right ventricular areas （ESA）, tricuspid annular plane systolic excursion （TAPSE）, RV myocardial performance index （MPI） and grade of tricuspid valve regurgitation （Gw~） were measured by transthoracic echocardiography. All the patients underwent transthoracic echocardiography and right heart catheterization before surgery, pulmonary vascular resistance（PVR）and right cardiac output（RCO） were measured by catheterization. Results Within 3 months after PEA, SPAP decreased significantly, EDA, ESA and MPI decreased （both P d0.01 ）,TAPSE increased and GTt decreased （both P d0.0l）. At the 12 and 24 month follow-up examinations, RV systolic pressure and function remained improved,respectively. The RV systolic pressure remained above 50 mmHg （1 mmHg = 0. 133 kPa） in only two cases. Pulmonary vascular resistance positively correlated with MPI （ r = 0.87, P 0. 001）. MPI also negatively correlated with RCO （ r = - 0.77, P d0. 001）. Conclusions In patients with CTEPH who undergo PEA, echocardiographic measurements of RV pressure and function show improvement,which is a useful tool for the evaluation of RV function.

关 键 词：超声心动描记术 肺栓塞 动脉内膜切除术 心室功能 右 

分 类 号：R445.1[医药卫生—影像医学与核医学]