实时三维超声心动图评价成人肺动脉高压患者右心室收缩功能  

Real-time three-dimensional echocardiography in the assessment of right ventricular systolic function in adults with pulmonary hypertension

作　　者：李亚南[1] 崔存英 刘园园[1] 胡彦斌 王莹[1] 刘琳[1] LI Yanan;CUI Cunying;LIU Yuanyuan;HU Yanbin;WANG Ying;LIU Lin(Department of Ultrasound,Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院超声科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2019年第1期59-62,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81401419);河南省医学科技攻关计划项目(201602173);河南省科技厅基础与前沿计划项目(132300410039)

摘　　要：目的探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)在成人肺动脉高压(pulmonary hypertension,PH)患者右心室收缩功能评估中的应用价值。方法 PH患者70例,依据常规经胸超声心动图测量的肺动脉收缩压分为轻度组(40～<50mm Hg)25例、中度组(50～<70mm Hg)25例、重度组(≥70mm Hg)20例,同期体检健康者30例为对照组。记录常规经胸超声心动图测量的右心室横径(right ventricular dimension,RVD)、左室射血分数(left ventricular ejection fraction,LVEF)、三尖瓣环收缩期位移(tricuspid annular planet systolic excursion,TAPSE),并计算右心室面积变化分数(right ventricular fractional area change,RVFAC)、右心室心肌做功指数(myocardial performance index,MPI)。应用RT-3DE测量右心室舒张末期容积(right ventricular end-diastolic volume,RVEDV)、右心室收缩末期容积(right ventricular end-systolic volume,RVESV)、右心室每搏输出量(right ventricular stroke volume,RVSV)、右室射血分数(right ventricular ejection fraction,RVEF);Pearson法分析RVD与RVEDV,各变量与RVEF的相关性。结果中度组、重度组LVEF[(59.10±2.55)%、(56.22±2.72)%]、TAPSE[(15.40±2.22)、(12.56±1.66)mm]、RVFAC[(42.20±2.70)%、(32.89±2.89)%]均低于对照组[(63.88±3.79)%、(22.25±3.99)mm、(56.00±3.62)%]、轻度组[(62.75±2.75)%、(19.63±2.50)mm、(49.13±3.83)%](P<0.05),RVD[(39.77±6.68)、(47.33±5.70)mm]、MPI(0.54±0.16、0.76±0.10)均高于对照组[(33.75±4.68)mm、0.39±0.01]、轻度组[(36.13±3.83)mm、0.43±0.02](P<0.05),且对照组与轻度组比较差异无统计学意义(P>0.05);重度组LVEF、TAPSE、RVFAC均低于中度组,RVD、MPI均高于中度组(P<0.05);对照组、轻度组、中度组、重度组RVEF[(54.50±5.26)%、(50.13±2.03)%、(40.70±4.21)%、(36.11±7.27)%]依次降低(P<0.05),4组RVSV比较差异无统计学意义(P>0.05);中度组、重度组RVEDV[(90.10±6.67)、(114.56±14.37)mL]、RVESV[(53.60±4.99)、(78.44±10.99)mL]均高Objective To investigate the application of real-time three-dimensional echocardiography(RT-3DE)in right ventricular systolic function in adults with pulmonary hypertension(PH).Methods Seventy patients with PH were divided into 25 patients with pulmonary arterial systolic pressure(PASP)of 40-<50mm Hg(mild group),25 patients with PASP of 50-<70mm Hg(moderate group)and 20 patients with PASP of≥70mm Hg(severe group)according to PASP level measured by echocardiography,and another 30 healthy volunteers were enrolled as controls(control group).Right ventricular dimension(RVD),left ventricular ejection fraction(LVEF),tricuspid annular planet systolic excursion(TAPSE),right ventricular fractional area change(RVFAC)and myocardial performance index(MPI)were detected by two-dimensional echocardiography in four groups.Right ventricular end-diastolic volume(RVEDV)and right ventricular end-systolic volume(RVESV),right ventricular stroke volume(RVSV)and right ventricular ejection fraction(RVEF)were measured by RT-3DE.Pearson correlation analysis was used to study the correlation between RVD and RVEDV,as well as between each parameter and RVEF.Results LVEF((59.10±2.55)%,(56.22±2.72)%),TAPSE((15.40±2.22),(12.56±1.66)mm)and RVFAC((42.20±2.70)%,(32.89±2.89)%)in moderate and severe groups were significantly lower(P<0.05),while RVD((39.77±6.68),(47.33±5.70)mm)and MPI(0.54±0.16,0.76±0.10)were significantly higher than those in control group((63.88±3.79)%,(22.25±3.99)mm,(56.00±3.62)%,(33.75±4.68)mm,0.39±0.01)and mild group((62.75±2.75)%,(19.63±2.50)mm,(49.13±3.83)%,(36.13±3.83)mm,0.43±0.02)(P<0.05),LVEF,TAPSE and RVFAC were significantly lower while RVD and MPI were significantly higher in severe group than those in moderate group(P<0.05),and there were no significant differences between control and mild groups(P>0.05).RVEF reduced gradually in control,mild,moderate and severe groups in turns((54.50±5.26)%,(50.13±2.03)%,(40.70±4.21)%,(36.11±7.27)%)(P<0.05).RVSV showed no significant difference among four group

关 键 词：肺动脉高压 实时三维超声心动图 右心室 收缩功能 

分 类 号：R544.1[医药卫生—心血管疾病] R540.45[医药卫生—内科学]