应用三尖瓣血流速度图评估肺动脉高压的研究  

Evaluation of Pulmonary Hypertension Using Tricuspid Regurgitation Spectrum

作　　者：孙丹丹[1,2] 侯颖[1] 侯传举[3] 袁丽君[1] 刘禧[1] 尚福军[4] 庚靖淞[3] 段云友[1] 

机构地区：[1]第四军医大学唐都医院超声科,陕西西安710038 [2]吉林医药学院医学影像系,吉林吉林132013 [3]沈阳军区总医院先心病内科,辽宁沈阳110840 [4]第四军医大学唐都医院心内科,陕西西安710038

出　　处：《中国医学影像学杂志》2017年第1期13-16,共4页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(81171349);吉林省科技发展计划项目(20130522016JH);吉林市科技计划项目(201464046)

摘　　要：目的平均肺动脉压(MPAP)是诊断和评价肺动脉高压的重要指标。本研究拟对比多普勒超声测量三尖瓣反流速度估测肺动脉收缩压(PASP)和三尖瓣反流速度诊断肺动脉高压2种方法,评价应用三尖瓣血流速度图对肺动脉高压的诊断效果。资料与方法收集2012年1月—2013年6月第四军医大学唐都医院以及沈阳军区总医院收治并拟行封堵术的先天性左向右分流心脏病患者80例。经心导管测量肺动脉压力,应用多普勒超声测量三尖瓣反流速度峰值。结果以导管测量的MPAP≥25 mm Hg为诊断标准,使用三尖瓣反流估算的PASP>30 mm Hg诊断肺动脉高压时,假阳性率为62.96%、假阴性率为0。使用三尖瓣反流速度诊断肺动脉高压具有较高的诊断一致性。分别以320 cm/s和340 cm/s为诊断界值时,假阳性率分别为14.81%和7.41%,假阴性率为15.91%和20.45%。结论对于左向右分流的先天性心脏病患者,采用超声心动图,并根据三尖瓣反流峰值速度直接诊断肺动脉高压可有效克服估算法存在较高假阳性率的问题,更适合基于MPAP为标准的肺动脉高压的诊断。Purpose The mean pulmonary artery（MPAP） has been widely used as an important parameter to diagnose and evaluate pulmonary hypertension（PH）. The purpose of this paper is to compare the efficacy of two methods in evaluating PH, including estimating pulmonary artery systolic pressure（PASP） using Doppler ultrasonography to measure tricuspid regurgitation（TR） velocity, and directly using the peak velocity of TR. Materials and Methods From January 2012 to June 2013, eighty patients with left-to-right shunt congenital heart diseases（CHD） planned for closure procedure in Tangdu Hospital of the Fourth Military Medical University and the General Hospital of Shenyang Military region were included in this prospective study, who underwent right heart catheterization to measure pulmonary artery pressure, and underwent Doppler ultrasonography to measure the peak velocity of TR. Results Using catheter-measured MPAP of ≥ 25 mm Hg as diagnostic reference, the false positive rate was 62.96%, and the false negative rate 0% when the estimated PASP of 〉30 mm Hg determined by TR method was used to diagnose PH. There was high diagnostic agreement when peak velocity of TR was used to diagnose PH. When 320 cm/s and 340 cm/s were used as diagnostic cutoff values, false positive rates were 14.81% and 7.41%, and false negative rates were 15.91% and 20.45%, respectively. Conclusion In patients with left-to-right shunt CHD, peak velocity of TR measured on echocardiography can be used to diagnose PH which overcomes the high false positive rate in estimation method. It is more suitable to diagnose PH when the MPAP is used as the diagnostic criterion.

关 键 词：室间隔缺损 房间隔缺损 动脉导管未闭 高血压 肺性 超声心动描记术 多普勒 彩色 心脏导管插入术 肺楔压 肺动脉 血压测定 血流速度 三尖瓣 

分 类 号：R445.1[医药卫生—影像医学与核医学] R544.1[医药卫生—诊断学]