多普勒超声心动图测定艾森曼格综合征患者肺动脉收缩压的准确性  

The accuracy of pulmonary arterial systolic pressure estimated by Doppler echocardiography in patients with Eisenmenger syndrome

作　　者：曾伟杰[1] 王晴 薛娇洁[1] 陈志冲[1] 程诗尧[1] 梁政[3] 张艺韬 欧毛德[1] 程康林[1] 

机构地区：[1]中山大学附属第六医院心内科,广东广州510000 [2]深圳孙逸仙心血管病医院心内科 [3]广东医学院附属医院心内科

出　　处：《中华高血压杂志》2016年第3期257-261,共5页Chinese Journal of Hypertension

摘　　要：目的评价彩色多普勒超声心动图（彩超）测定艾森曼格综合征患者肺动脉收缩压（PASP）的准确性。方法本研究设计为回顾性、观察性研究。通过查阅病历收集2010年1月至2014年12月期间确诊为艾森曼格综合征的患者72例的病历资料。患者均在右心导管检查前72h内完成彩超检查。与右心导管测量的PASP比较,评价彩超测量PASP的准确性。结果彩超测PASP（100.6±25.4）mm Hg,导管测PASP（109.8±28.2）mm Hg,两者比较差异有统计学意义（P=0.003）,Pearson相关分析显示两者测量的PASP中度相关（r=0.57,P〈0.01）。Bland-Altman分析显示,彩超测量与右心导管测量PASP平均差值为-9.2mm Hg（95%CI-58.2~39.8mm Hg）。与右心导管测量值比较,彩超高估〉10mm Hg者14例（19.4%）,低估〉10mm Hg者32例（44.4%）。将患者按三尖瓣前分流（房间隔缺损,28例）与三尖瓣后分流（室间隔缺损20例＋动脉导管未闭24例）比较,两组低估〉10mm Hg例数所占比例差异有统计学意义（25.0%比56.8%,P=0.008）。结论彩超定量测定艾森曼格综合征患者PASP存在一定局限性。对于三尖瓣后分流患者,PASP更易出现低估。Objective To investigate the accuracy of pulmonary arterial systolic pressure（PASP）estimated by Doppler echocardiography in patients with Eisenmenger syndrome. Methods This was a retrospective and observational study. The datum of 72 cases of hospitalized patients diagnosed with Eisenmenger syndrome between January 2010 and December 2014 were collected by reviewing medical records. All patients underwent Doppler echocardiography examination within 72 hours before right heart catheterization. By comparing with the PASP determined by right heart catheterization,the accuracy of the PASP estimated by Doppler echocardiography was evaluated.Results There was a significant difference between the PASP determined by right heart catheterization and the PASP estimated by echocardiography[（109.8±28.2）vs（100.6±25.4）mm Hg,P=0.003]. Pearson correlation analysis showed that there was a moderate correlation between PASP determined by the right heart catheterization and estimated by echocardiography（r=0.57,P〈0.01）. Based on Bland-Altman analysis,the mean difference between the PASP estimated by echocardiography and determined by right heart catheterization was-9.2mm Hg（95% CI-58.2to 39.8mm Hg）. Compared to right heart catheterization,Doppler echocardiography over-estimated PASP by 10 mm Hg in 14cases（19.4%）and underestimated PASP about 10 mm Hg in 32cases（44.4%）.There was a significant difference in underestimation rate between patients with pre-tricuspid bypass（atrial septal defect,25.0%）and with post-tricuspid bypass（ventricular septal defect and patent ductus arteriosus,56.8%,P=0.008）. Conclusion Doppler echocardiography had some certain limitations in the estimation of PASP in patients with Eisenmenger syndrome. Doppler echocardiography may be more likely to underestimate PASP in patients with post-tricuspid bypass.

关 键 词：肺动脉高压 彩色多普勒超声心动图 右心导管 

分 类 号：R541.1[医药卫生—心血管疾病]