肺动脉瓣收缩期跨瓣压差在评价房间隔缺损患者肺动脉收缩压中的作用  

The role of pulmonary valve pressure gradient in the evaluation of pulmonary artery systolic pressure in patients with atrial septal defect

作　　者：关欣 杜鑫[1] 万征[1] 杨振文[1] 杨孟云[1] 邬天凤 GUAN Xin;DU Xin;WAN Zheng;YANG Zhen-wen;YANG Meng-yun;WU Tian-feng(Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院,300052

出　　处：《天津医药》2018年第7期715-719,共5页Tianjin Medical Journal

摘　　要：目的探讨超声心动图测定肺动脉瓣收缩期跨瓣压差在评价房间隔缺损(ASD)患者肺动脉收缩压(PASP)中的作用。方法纳入天津医科大学总医院就诊的68例ASD患者,在封堵术前采用三尖瓣反流法估测PASP,测定肺动脉瓣收缩期血流速度得到跨瓣压差,两者差值计算得到肺动脉收缩压校正值(PASP’),分别与肺动脉收缩压导管测值(PASPr)比较。根据缺损大小,将患者分为A组(缺损内径≤15 mm)和B组(缺损内径>15 mm),观察各组患者超声测值与心导管测值异同。结果 A组患者PASP[(31.66±6.76)mm Hg]、PASP’[(26.86±6.66)mm Hg]与PASPr[(28.79±6.43)mm Hg]差异有统计学意义(P<0.05);B组患者PASP高于PASPr[(45.29±13.49)mm Hg vs.(34.56±9.47)mm Hg,P<0.05],而PASP’[(37.30±12.71)mm Hg]与PASPr差异无统计学意义(P>0.05)。A组、B组患者PASPr与PASP均呈正相关(r分别为0.664、0.588,P<0.01),校正后A组、B组患者PASPr与PASP’相关系数均有所提高(r分别为0.700、0.645,P<0.01)。结论通过肺动脉瓣收缩期跨瓣压差校正三尖瓣反流法测得的PASP可以较准确地预测缺损内径大于15 mm的ASD患者的PASP。Objective To investigate the role of pulmonary valve pressure gradient in the estimation of pulmonary artery systolic pressures(PASP)in patients with atrial septal defect(ASD).Methods Sixty eight patients with ASD and hospitalized in Tianjin Medical University General Hospital were included in this study.The tricuspid regurgitation pressure gradient method was used for measuring PASP before interventional occlusion operation.And pulmonary valve pressure gradient was measured through pulmonary valve velocity to calculate corrected values(PASP’),which were compared with those(PASPr)obtained by right cardiac catheterization(RHC)respectively.The patients were divided into group A(defect size≤15 mm)and group B(defect size>15 mm)by the size of defect.The measurements obtained by ultrasound echocardiography(UCG)and RHC were compared between the two groups.Results There were statistically significant differences between PASP[(31.66±6.76)mmHg],PASP’[(26.86±6.66)mmHg]and PASPr[(28.79±6.43)mmHg]in group A(P<0.05).The PASP was significantly higher than PASPr[(45.29±13.49)mmHg vs.(34.56±9.47)mmHg](P<0.05),but there was no significant difference between PASP’[(37.30±12.71)mmHg]and PASPr in group B(P>0.05).Values of PASPr were positively correlated with PASP(r=0.664,0.588 respectively,P<0.01)in group A and group B.The correlation coefficients of PASPr and PASP’were improved in two groups after adjusted with pulmonary valve pressure gradient(respectively r=0.700,0.645,P<0.01).Conclusion The adjusted PASP calculated by tricuspid regurgitation pressure gradient method with pulmonary valve pressure gradient can improve the accuracy of echocardiographic estimates of PASP in ASD patients with the defect size>15 mm.

关 键 词：房间隔缺损 超声心动图描记术 压力 心导管术 肺动脉收缩压 肺动脉瓣收缩期跨瓣压差 

分 类 号：R541.11[医药卫生—心血管疾病]