肺静脉血流速度在成人房间隔缺损相关性肺动脉高压中的应用  

The application of pulmonary vein velocity in adult atrial septal defect associated pulmonary arterial hypertension

作　　者：周胤 谢楠山 罗冬玲 李贺智 张曹进 ZHOU Yin;XIE Nan-shan;LUO Dong-ling;LI He-zhi;ZHANG Cao-jin(School of Medicine,South China University of Technology,Guangzhou 510000,China)

机构地区：[1]华南理工大学医学院,广东广州510000 [2]南方医科大学第二临床医院心内科 [3]中山大学附属第八医院心内科 [4]广东省心血管病研究所

出　　处：《中国介入心脏病学杂志》2021年第5期260-265,共6页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划(2018YFC1002600);广东省自然科学基金(2018A030313785);广东省科技计项目(2017A070701013、2017B090904034、2017B030314109、2019B020230003)。

摘　　要：目的分析肺静脉血流速度在成人房间隔缺损(ASD)相关性肺动脉高压(PAH)中的应用。方法回顾性分析2008年1月1日至2009年3月30日在广东省心血管病研究所行彩色多普勒超声检查肺静脉频谱的成人ASD-PAH患者44例,比较接受介入封堵与未封堵患者的肺静脉血流速度,分析其与血流动力学参数之间的相关性,并观察不同流速患者治疗后心脏结构的变化情况。结果根据是否介入封堵分为封堵组(32例)和未封堵组(12例)。封堵组患者平均肺静脉流速明显高于未封堵组[(0.75±0.10)m/s比(0.60±0.14)m/s,P<0.001],差异有统计学意义。而且,ASD-PAH患者的左下肺静脉血流速度与肺血管阻力(相关系数β=–0.43,P=0.005)、平均肺动脉压(相关系数β=–0.53,P<0.001)呈负相关,而与混合静脉血氧饱和度(β=0.51,P<0.001)、心脏指数(β=0.37,P=0.014)呈正相关。中位随访时间为46(7,63)个月,共25例患者规律随访,根据术前平均肺静脉流速分为肺静脉流速>0.7 m/s组(12例)和肺静脉流速≤0.7 m/s组(13例)。肺静脉流速>0.7 m/s组患者右心房内径[(44.08±6.73)mm比(50.08±6.43)mm,P=0.017]、右心室内径[(49.00±6.63)mm比(54.75±6.69)mm,P=0.011]较术前明显缩小,差异均有统计学意义;而肺静脉流速≤0.7 m/s组患者,右心房、右心室内径恢复不显著。结论肺静脉血流速度与ASD-PAH患者的血流动力学参数存在明显相关性,有望成为ASD-PAH手术评判及预后评估的重要指标之一。Objective This study was aimed to explore the value of the velocity of pulmonary veins in adult atrial septal defect associated pulmonary arterial hypertension(ASD-PAH).Methods Forty-four patients with ASD-PAH were enrolled in Guangdong Cardiovascular Institute during January 1st,2008 and March 30th,2009.All patients received echocardiographic examinations of the pulmonary veins and right heart catheterization.We compared pulmonary vein velocity between patients with percutaneous defect closure and those without,analyzed the correlation between pulmonary vein velocity and hemodynamic parameters.Patients were followed up and the change of cardiac structures were compared.Results Thirty-two patients received percutaneous defect closure,in whom the mean pulmonary vein velocity was significantly higher than those who did not(n=12)[(0.75±0.10)m/s vs.(0.60±0.14)m/s,P<0.001].Besides,the left lower pulmonary vein velocity of patients with ASD-PAH was negatively correlated with PVR(correlation coeffi cientβ=-0.43,P=0.005),mean pulmonary artery pressure(β=-0.53,P<0.001),and positively correlated with the mixed oxygen saturation(β=0.51,P<0.001)and cardiac index(β=0.37,P=0.014).After a median follow-up of 46(7,63)months,among 25 patients with regular follow up,the right atrial(RA)and ventricular(RV)sizes were significantly reduced in patients with a higher than 0.7 m/s pulmonary vein velocity[RA:(44.08±6.73)mm vs.(50.08±6.43)mm,P=0.017;RV:(49.00±6.63)mm vs.(54.75±6.69)mm,P=0.011].While in those with a velocity lower than 0.7 m/s,the sizes of RA and RV did not change significantly in those with a lower than 0.7 m/s velocity.Conclusions A significant correlation was observed between pulmonary vein velocity and the hemodynamic parameters of ASD-PAH patients.This suggests that pulmonary vein velocity could be served as an important indicator for disease evaluation and long-term prognosis in ASD-PAH adult patients.

关 键 词：房间隔缺损 肺动脉高压 肺静脉血流速度 彩色多普勒超声 

分 类 号：R543.2[医药卫生—心血管疾病]