右心声学造影检测肺血管病心内及肺循环右向左分流的临床价值  

The Value of Saline Contrast Echocardiography in Clinical Evaluation of Right to Left Shunt in Pulmonary Vascular Disease

作　　者：翟亚楠 李爱莉[1] 谢万木[2] 万钧[2] 周宝风 刘敏[3] 翟振国[2] Zhai Yanan;Li Aili;Xie Wanmu;Wan Jun;Zhou Baofeng;Liu Min;Zhai Zhenguo(Department of Cardiology,China-Japan'Friendship Hospital,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,Center for Respiratory Diseases,China-Japan'Friendship Hospital,Beijing 100029,China;Department of Radiology,China-Japan'Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院心脏科,北京市100029 [2]中日友好医院呼吸与危重症医学二部,北京市100029 [3]中日友好医院放射诊断科,北京市100029

出　　处：《中国超声医学杂志》2021年第9期1002-1005,共4页Chinese Journal of Ultrasound in Medicine

基　　金：首都卫生发展科研专项项目(No.2020-2-4063);国家临床重点专科建设项目(No.2020-QTL-009);中国医学科学院与健康科技创新工程(No.2018-I2M-1-003)。

摘　　要：目的探讨超声心动图右心声学造影(SCE)检测肺血管病右向左分流(RLS)的临床价值。方法回顾性分析135例肺动脉高压(PH)及疑诊其他肺血管病患者的SCE结果,对SCE结果进行定性及半定量分级评估。结果135例患者中94例为确诊PH患者,其中SCE帮助诊断先天性心脏病9例,其余85例PH患者中,SCE检测卵圆孔未闭(PFO)RLS检出率12.9%,63.6%为Ⅲ~Ⅳ级RLS,肺循环RLS(P-RLS)检出率43.5%,97.2%为I~Ⅱ级RLS。存在PFO-RLS分流、P-RLS与无分流三者之间的WHO功能分级、右心房横径、右心室横径、右心房压比较,差异有统计学意义(χ^(2)=6.1,P=0.045;F=15.9,P=0.000;F=6.8,P=0.002;F=5.3,P=0.009)。另外41例非PH患者中,13例为肺栓塞合并脑栓塞患者,SCE发现6例存在PFO-RLS;11例为疑诊肺动静脉瘘患者,3例存在P-RLS;17例为不明原因低氧血症查因者,4例存在Ⅳ级P-RLS。结论SCE对心内及肺循环RLS进行定性及定量检测,在PH与其他肺血管病的诊断评估方面有重要应用价值。Objective To evaluate the role of saline contrast echocardiography(SCE)in the diagnosis of right to left shunt(RLS)in pulmonary vascular disease.Methods The results of SCE in 135 patients with pulmonary hypertension(PH)and other suspected pulmonary vascular disease were analyzed retrospectively.Results Among 135 patients,94 cases were diagnosed as PH,9 cases of which were diagnosed as congenital heart disease by SCE.Of the other 85 PH patients,12.9%were diagnosed as patent foramen ovale(PFO)RLS by SCE,and 43.5%were diagnosed as pulmonary RLS(P-RLS).There was a significant difference in WHO functional class,right atrial diameter,and right atrial pressure among patients with PFO-RLS,P-RLS,and no RLS(χ^(2)=6.1,P=0.045;F=15.9,P=0.000;F=6.8,P=0.002;F=5.3,P=0.009).In the other 41 cases of non-PH patients,13 cases were diagnosed as pulmonary embolism combined with cerebral infarction,PFO-RLS was found in 6 cases by SCE.In 11 patients with suspecting pulmonary arteriovenous fistula,P-RLS was found in 3 cases.In 17 patients with unexplained hypoxemia,gradeⅣP-RLS was found in 4 cases.Conclusions SCE has an important value in the diagnosis and evaluation of PH and other pulmonary vascular diseases.

关 键 词：超声心动描记术 肺血管病 右向左分流 声学造影剂 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.2[医药卫生—诊断学]