右心房压力和混合静脉血氧饱和度比值在肺动脉高压恶化中的预测价值  

Predictive value of right atrial pressure corrected mixed venous oxygen saturation in clinical worsening of pulmonary arterial hypertension

作　　者：柳江海 关欣[1] LIU Jianghai;GUAN Xin(Department of Cardiology, Shaanxi Baoji People＇s Hospital, Shaanxi, Baoji, 721000, China)

机构地区：[1]宝鸡市人民医院心血管内科,陕西宝鸡721000

出　　处：《临床心血管病杂志》2018年第5期494-497,共4页Journal of Clinical Cardiology

摘　　要：目的:评估基于右心导管术的血流动力学参数对肺动脉高压(pulmonary arterial hypertension,PAH)患者病情恶化的预测价值。方法:回顾性分析120例经右心导管检查确诊为毛细血管前PAH患者的血流动力学参数。根据有无病情恶化将患者分为病情恶化组和无恶化组,比较两组患者基线水平的血流动力学参数差异性,并以Cox回归分析评估影响PAH患者病情恶化进展时间的相关危险因素。结果:85例(70.8%)患者的随访期内出现PAH病情恶化。与无病情恶化组患者相比,病情恶化组患者具有较低的心脏指数(cardiac index,CI)、较高的右心房压力(right atrial pressure,RAP)、较高的肺血管阻力(pulmonary vascular resistance,PVR)、较低的混合静脉血氧饱和度(mixed venous oxygen saturation,SVO_2)和较高的RAP与SVO_2比值(cSVO_2)。Cox回归分析证实,cSVO_2(HR=2.50,95%CI:1.86~5.59,P=0.001)与患者的PAH病情恶化的进展时间具有较强的相关性。结论:RAP和cSVO_2是PAH患者病情恶化的独立危险因素,可用于PAH患者的预后评估。Objective：This study was aimed to evaluate the predictive value of hemodynamic parameters based on right cardiac catheterization for clinical worsening in patients with pulmonary arterial hypertension（PAH）.Method：A retrospective analysis of 120 patients diagnosed as pre-capillary PAH by right heart catheterization with hemodynamic parameters was performed.The patients were divided into groups with or without clinical worsening respectively,according to the occurance of clinical worsening signs during follow-up.The differences of hemodynamic parameters between the two groups were compared respectively,and the risk factors of the progression time of PAH worsening were evaluated by Cox regression analysis.Result：The 85 cases（70.8%）were diagnosed clinical worsening within the follow-up.Compared with non-worsening groups,patients with clinical worsening were showed lower cardiac index（CI）,higer right atrial pressure higher（RAP）,higher pulmonary vascular resistance（PVR）,lower mixed venous oxygen saturation（SVO2）and higher RAP to SVO2 ratio（cSVO2）.Cox regression analysis confirmed that cSVO2（HR=2.50,95%CI：1.86-5.59,P=0.001）had strong correlation with the time to clinical worsening in PAH patients.Conclusion：The RAP to SVO2 ratio（cSVO2）is an independent risk factors for the clinical worsening in PAH patients,which can be used for the prognostic evaluation in PAH patients.

关 键 词：肺动脉高压 右心房压力 混合静脉血氧饱和度 恶化 

分 类 号：R543.2[医药卫生—心血管疾病]