超声多普勒方法估测肺动脉平均压的效果比较  

Comparison of Doppler Ultrasonography Methods on Estimating Pulmonary Artery Mean Pressure

作　　者：孙丹丹[1] 侯颖[1] 袁丽君[1] 侯传举[2] 刘禧[1] 尚福军[3] 段云友[1] 

机构地区：[1]解放军第四军医大学唐都医院超声科,西安市710038 [2]沈阳军区总医院先心病内科 [3]解放军第四军医大学唐都医院心内科,西安市710038

出　　处：《中国超声医学杂志》2016年第8期714-716,共3页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.81171349);吉林省科技发展计划项目(No.20130522016JH);吉林市科技计划项目(No.201464046)

摘　　要：目的评价四种超声多普勒指标估测肺动脉平均压(PAMP)的效果。方法收集预行先心病封堵术的患者80例,以右心导管测量的PAMP为诊断标准,与肺动脉反流峰值速度(PRV)、三尖瓣反流峰值速度(TRV)、肺动脉频谱加速时间(AT)、右室射血前期时间与AT比值(PEP/AT)估测的PAMP进行比较。结果四种方法估测的结果与导管值具有相关性(r=0.739、0.798、0.430、0.481,P<0.001)。ROC曲线显示PRV、TRV、PEP/AT的诊断价值较高,AT的诊断价值中等。Kappa值提示PRV的诊断一致性较高,TRV、PEP/AT中度,AT较差。结论应用超声多普勒估算先心病患者PAMP时,首先推荐使用肺动脉瓣反流和三尖瓣反流峰值速度,当不存在瓣膜反流时,可以使用肺动脉频谱指标作为补充。Objective The aim of this study was to evaluate the efficacy of using four ultrasonography methods to estimate pulmonary artery mean pressure（PAMP）.Methods Eighty patients were included who were candidates for congenital heart diseases（CHD）occlusion procedure.PAMP measured by right heart catheterization was used as the gold standard.PAMP was estimated by four ultrasonography Doppler methods,including peak velocity of pulmonary regurgitation（PRV）,peak velocity of tricuspid regurgitation（TRV）,pulmonary spectral acceleration time（AT）,and the ratio between right ventricular pre-ejection period and AT（PEP/AT）.Results Correlation was found between catheter method and Doppler methods（r=0.739,0.798,0.430,0.481,P〈0.001）.Higher diagnostic values were seen in PRV,TRV and PEP/AT,and AT had moderate diagnostic value by ROC curves.PRV had high diagnostic consistency,TRV and PEP/AT had moderate diagnostic consistencies,While AT had poor diagnostic consistency.Conclusions The PRV and TRV are priority recommended as Doppler ultrasonography parameters to estimate PAMP for patients with CHD.The parameters from pulmonary artery spectrum can be used as a supplement when the regurgitation is absent.

关 键 词：肺动脉高压 多普勒超声 右心导管 肺动脉平均压 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.1[医药卫生—诊断学]