超声心动图评价继发肺动脉高压慢性阻塞性肺疾病患者右心室功能的临床价值  

Clinical value of echocardiography in the evaluation of right ventricular function of COPD patients with secondary PAH

作　　者：刘丽莉[1] 杨炳昂[1] 张洁[1] 唐海霞[1] 钟文津[1] 景香香[1] LIU Li-li;YANG Bing-ang;ZHANG Jie(Department of Ultrasound,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院超声科,海南海口570311

出　　处：《中国医学装备》2018年第9期66-70,共5页China Medical Equipment

摘　　要：目的:探讨超声心动图在继发肺动脉高压(PAH)慢性阻塞性肺疾病(COPD)患者右心室功能评估中的临床应用价值。方法:回顾性分析80例COPD患者超声心动图资料,将继发PAH患者纳入PAH组,无PAH患者纳入无PAH组,每组40例。使用超声心动图检测及处理后获得二维超声数据、M型超声数据、多普勒超声数据及二维斑点追踪数据,比较PAH组与无PAH组各项数据。结果:与无PAH组相比,PAH组右室心底舒张末横径(RV-b DD)及右室中部舒张末横径(RV-m DD)增大,右室游离壁舒张末期厚度(RVDT)增厚(t=13.936,t=19.421,t=46.991;P<0.05);PAH组右室收缩末期面积(RVESA)及右室舒张末期面积(RVEDA)增大,右室面积变化分数(RVFAC)减低(t=12.933,t=3.839,t=27.32;P<0.05);PAH组MPA增宽(t=15.334,P<0.05);PAH组三尖瓣环收缩期位移(TAPSE)减低(t=15.665,P<0.05);PAH组肺动脉收缩压(SPAP)升高(t=25.898,P<0.05);PAH组E/A-tv下降、e′/a′-tv下降、s′-tv降低(t=16.771,t=11.626,t=17.155;P<0.05);PAH组ET缩短,右室等容收缩时间(ICT)+右室等容舒张时间(IRT)延长,右室心肌做功指数(RVMPI)增大(t=7.769,t=20.662,t=36.151;P<0.05);PAH组右心室整体长轴应变值(RVGLS)减低(t=10.401,P<0.05);比较差异有统计学意义(P<0.05)。结论:继发PAH-COPD患者右室功能明显下降。超声心动图能够无创、准确评价继发肺动脉高压COPD患者右心功能,为临床评估患者病情、预后及选择治疗方案提供依据。Objective:To discuss the clinical value of echocardiography in the evaluation of right ventricular function of chronic obstructive pulmonary disease(COPD)patients with secondary pulmonary arterial hypertension(PAH).Methods:The echocardiography data of 80 patients with COPD were retrospectively analyzed,and all of them were divided into PAH group(40 cases)and non-PAH group(40 cases)according to whether secondary PAH existed in patients.After echocardiography was applied to detect and process these data,series of data included two-dimensional echocardiography data,M-mode echocardiography data,Doppler echocardiography data and two-dimensional speckle tracking imaging data were obtained.And then,the each kind of data between the two groups were compared.Results:Compared with non-PAH group,the RV-bDD and RV-mDD of PAH group were significantly increased,RVDT was significantly thickened(t=13.936,t=19.421,t=46.991,P<0.05).The RVESA and RVEDA of PAH group were significantly increased,and the RVFAC was significantly decreased(t=12.933,t=3.839,t=27.32,P<0.05).And series of indexes,that included broadening MPA,decreasing TAPSE,increasing SPAP,declining E/A-tv and e'/a'-tv and s'-tv,shortening ET,lengthening ICT+IRT,magnifying RVMPI and decreasing RVGLS,of PAH group were significantly different with that of non-PAH group(t=15.334,t=15.665,t=25.898,t=16.771,t=11.626,t=17.155,t=7.769,t=20.662,t=36.151,t=10.401,P<0.05),respectively.Conclusions:The right ventricular function of COPD patients with secondary PAH significantly decreased.Echocardiography can noninvasively and accurately assess right ventricular function of these patients and it can provide basis for evaluating patient's condition and prognosis and choosing therapeutic schedule for them in clinical practice.

关 键 词：超声心动图描记术 肺动脉高压 慢性阻塞性肺疾病 右心室功能 

分 类 号：R445.1[医药卫生—影像医学与核医学]