慢性心力衰竭患者肺部B线积分与右心室前后负荷及右心室收缩功能的相关性分析  

Correlation analysis of lung line B score with right ventricular load and systolic function in patients with chronic heart failure

作　　者：贾论文 吴海燕[2] 陈继[2] 李蓬[2] 王柳 JIA Lunwen;WU Haiyan;CHEN Ji;LI Peng;WANG Liu(Graduate Educational Base of Dongfeng General Hospital of Sinopharm of Jinzhou Medical University,Shiyan 442008,China;Department of Ultrasound Medicine,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan 442008,China)

机构地区：[1]锦州医科大学国药东风总医院研究生培养基地,湖北十堰442008 [2]湖北医药学院附属国药东风总医院超声医学部,湖北十堰442008

出　　处：《医学影像学杂志》2023年第4期567-571,共5页Journal of Medical Imaging

基　　金：湖北省卫生健康委科研立项项目(编号:WJ2021F051)。

摘　　要：目的探索右心室前后负荷及收缩功能在慢性心力衰竭患者血管外肺水含量增多中的价值。方法选取130例临床诊断为慢性心力衰竭的患者,根据肺部B线积分<5分(A组)或≥5分(B组)分为两组,超声心动图记录患者二尖瓣口舒张早期峰值血流速度与二尖瓣瓣环舒张早期峰值运动速度比值(E/e’)、肺动脉收缩压(PASP)、舒张末期右心室与左心室内径之比(RV/LV)、肺动脉主干血流的速度时间积分(VTI)、右心室每博量(RVSV)、三尖瓣环收缩期位移(TAPSE)、面积变化分数(FAC)、三尖瓣环收缩期峰值速度(S′),右心室每博量与左心室每博量比值(RVSV/LVSV),比较两组患者以上参数的差异。应用多元线性回归分析上述各参数与肺部B线积分的相关性,重点探讨慢性心衰患者发生肺水肿的主要影响因素。结果A组和B组在性别、年龄、心率、RV/LV、E/e’、S′方面比较,差异无统计学意义(P>0.05),但A组的肺动脉VTI、RVSV、TAPSE、FAC、RVSV/LVSV均高于B组,差异有统计学意义(P<0.05);其中,前负荷指标肺动脉VTI及右心室收缩功能指标TAPSE、FAC与肺部B线积分呈负相关(r=-0.319、-0.317、-0.259,P<0.05),经多元线性回归分析调整肺动脉VTI、RVSV、TAPSE、FAC及LVEF影响因素后发现,肺部B线积分与肺动脉VTI呈独立相关(β=-0.294,P<0.05)。结论心力衰竭患者合并肺部B线积分增高时右心功能受损,前负荷指标肺动脉VTI及右心室收缩功能指标FAC、TAPSE与肺部B线积分负相关,肺部B线积分可作为判断右心收缩功能的重要指标之一。Objective To explore the value of right ventricular load and systolic function in the increase of extravascular pulmonary fluid in patients with chronic heart failure.Methods A total of 130 patients with clinically diagnosed chronic heart failure were included,the patients were divided into two groups according to the pulmonary b-line score<5(group A)or≥5(group B).The following echocardiographic parameters were determined:ratio of early diastolic peak flow velocity of mitral valve orifice to early diastolic peak motion velocity of mitral valve annulus(E/e’),Pulmonary artery systolic pressure(PASP),ratio of end-diastolic right ventricular to left ventricular diameter(RV/LV),main pulmonary artery velocity time integral(VTI),right ventricular stroke volume(RVSV),tricuspid annular plane systolic excursion(TAPSE),fractional area change(FAC),tissue Doppler-derived tricuspid ann-ular highest systolic velocity(S′),and ratio of right ventricular stroke volume to left ventricular stroke volume.The correlation between pulmonary B line integration and pulmonary VTI,RVSV,TAPSE,FAC,S',E/e',RV/LV was analyzed.Multiple linear regression was used to analyze the correlation between the above parameters and the lung B line integral.The main influencing factors of pulmonary edema in patients with chronic heart failure were discussed.Results There were no significant differences in gender,age,heart rate,RV/LV,E/e'and S'between group A and group B(P>0.05).However,pulmonary VTI,RVSV,TAPSE,FAC and RVSV/LVSV in group A were higher than those in group B,with statistical significance(P<0.05).Preload index pulmonary VTI and right ventricular systolic function index TAPSE and FAC were negatively correlated with lung B line score(r=-0.319,-0.317,-0.259,P<0.05).After adjusting the factors affecting pulmonary VTI,RVSV,TAPSE,FAC and LVEF,the pulmonary b-line integral was independently correlated with pulmonary VTI(β=-0.294,P<0.05).Conclusion Right heart function is impaired in patients with heart failure with increased lung B line score.P

关 键 词：慢性心力衰竭 肺部B线积分 右心收缩功能 超声检查 

分 类 号：R541[医药卫生—心血管疾病] R445.1[医药卫生—内科学]