超声诊断左心疾病相关肺动脉高压对慢性左心衰竭患者预后的价值研究  

The relationship between pulmonary artery pressure estimated by ultrasound and the prognosis of patients with chronic left heart failure

作　　者：章慧慧[1] 张妙林[1] 袁红[1] 孙金栋[1] 

机构地区：[1]浙江省杭州市余杭区第一人民医院心内科,311100

出　　处：《心电与循环》2016年第4期249-252,共4页Journal of Electrocardiology and Circulation

摘　　要：目的评估超声估测肺动脉压与慢性左心衰竭患者预后的关系。方法选择住院的慢性心力衰竭患者（心功能NYHA分级Ⅲ-Ⅳ级）110例,根据超声心动图测定肺动脉压力分为两组：肺动脉收缩压（PASP）50-70mm Hg（50-70mm Hg组）61例,PASP〉70mm Hg（〉70mm Hg组）49例,两组患者均进行优化抗心力衰竭药物治疗,比较住院治疗后6 min步行距离、动脉血CO2分压、左心室射血分数（LVEF）、瓣膜反流程度,平均住院天数,随访1年内再入院率与病死率。结果 50-70mm Hg组患者治疗后6min步行试验距离较〉70mm Hg组长,CO2分压、住院平均天数较〉70mm Hg组低,差异均有统计学意义（均P〈0.05）。两组患者肺动脉瓣、主动脉瓣中度及以上反流在治疗后百分率差异有统计学意义（均P〈0.05）。〉70mm Hg组患者1年内再入院率、病死率[21例（42.9%）,死亡9例（18.4%）]均高于50-70mm Hg组[13例（21.3%）,死亡3例（4.9%）],差异均有统计学意义（χ2=5.907、5.057,均P〈0.05）。结论超声估测肺动脉压〉70mm Hg的慢性心力衰竭患者预后较差。Objective To investigate the pulmonary artery pressure （PAP） estimated by ultrasound and the prognosis of patients with chronic left heart failure（CLHF）. Methods 110 inpatients with CLHF were divided into group A（PASP 50 - 70mmHg, n=61） and group B （PASP〉70mmHg, n=49） according to PAP estimated by ultrasound. All patients received optimized medicine treatment. 6-minute walking distance, arterial PCO2, left ventricular ejection fraction and valvular regurgitation after treatment, average hospital stay, re-hospitalization and mortality during follow up one year were compared between the two groups. Results 6-minute walking distance was significantly longer, arterial PCO2 and average hospital stay were significantly lower in group A than in group B （all P〈0.05）. The percentage of patients with moderate or severe pulmonary and aortic regurgitation was significantly different between the two groups. Re-hospitalization and mortality were significantly higher in group B （42.9%, 18.4%, respectively） than in group A （21.3%, 4.9%）（all P〈0.05）. Conclusion The prognosis is relatively poor for patients with CLHF and ultrasound estimation of PAP 〉70 mmHg.

关 键 词：肺动脉高压 慢性心力衰竭 诊断 预后 

分 类 号：R544.1[医药卫生—心血管疾病] R541.6[医药卫生—内科学]