踏车运动负荷超声心动图评价健康成人高海拔地区暴露后右心-肺循环单元的改变  

Supine bicycle exercise stress echocardiographic assessment of the right heart-pulmonary circulation unit after high-altitude exposure in healthy adults

作　　者：徐芸 王胰[1] 张清凤[1] 王凯[2] 王斯佳 尹立雪[1] 敬勇[1] Xu Yun;Wang Yi;Zhang Qingfeng;Wang Kai;Wang Sijia;Yin Lixue;Jing Yong(Department of Cardiovascular Ultrasound and Cardiac Function,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cardiovascular Disease,Chengdu 610000,China;Department of Emergency Medicine,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610000,China)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心血管超声及心功能科,超声心脏电生理学与生物力学四川省重点实验室,四川省心血管病临床医学研究中心(国家心血管疾病临床医学研究中心四川分中心),成都610000 [2]四川省医学科学院·四川省人民医院(电子科技大学附属医院)急诊科,成都610000

出　　处：《中华超声影像学杂志》2025年第1期33-38,共6页Chinese Journal of Ultrasonography

摘　　要：目的采用踏车运动负荷超声心动图(SE)观察健康人群在高海拔地区暴露后心血管系统适应性变化,揭示健康人群急性高海拔地区暴露后右心功能、肺血管储备及右心室收缩储备的变化。方法前瞻性纳入健康成人36例,分别在低海拔地区(海拔500 m)和高海拔地区(海拔3600 m)进行SE检查,脱机分析获取高海拔地区及低海拔地区静息以及峰值的超声参数:三尖瓣反流速度(TRV)、三尖瓣环收缩期峰值速度(TV-s′)、右心室舒张末面积(RVEDA)、右心室收缩末面积(RVESA)、右心室面积变化分数(RVFAC)、右心室基底横径(RVD1)、右心室中段横径(RVD2)、右心室纵径(RVD3)、右心室游离壁纵向应变(RVFWS)、右心室整体纵向应变(RVGLS)、左心室心排出量(CO)等;计算肺动脉收缩压(PASP)、平均肺动脉压力(mPAP)、肺阻力(PVR)、三尖瓣环收缩期位移(TAPSE)/PASP;计算肺血管储备及右心室收缩储备指标,即mPAP/CO斜率、三尖瓣环收缩期位移变化(ΔTAPSE)、右心室面积变化分数变化(ΔRVFAC)、右心室整体长轴应变变化(ΔRVGLS)、三尖瓣环侧壁s峰值速度变化(ΔTV-s′)。比较高海拔地区与低海拔地区以上参数的差异。结果静息状态下,高海拔地区TRV、PASP、mPAP、PVR、RVD2、RVD3高于低海拔地区(均P<0.05),TAPSE/PASP、RVFAC、RVGLS、RVFWS低于低海拔地区(均P<0.05);峰值状态下,高海拔地区TRV、PASP、mPAP、PVR、RVAD、RVAS、RVD2、RVD3高于低海拔地区(均P<0.05),RVFAC小于低海拔地区(P<0.05)。右心室收缩储备及肺血管储备:高海拔地区mPAP/CO斜率高于低海拔地区,ΔTV-S'及ΔRVFAC低于低海拔地区(均P<0.05);两海拔地区ΔTAPSE及ΔRVGLS差异无统计学意义(均P>0.05)。结论急性高海拔地区暴露后,右心室适应性扩张,肺血管储备及右心室收缩储备功能降低。ObjectiveTo observe the adaptive changes in the cardiovascular system after travelling to high altitude in healthy people using supine bicycle exercise stress echocardiography(SE),and to reveal the changes in right heart function,pulmonary vascular reserve and right ventricular systolic reserve in healthy people after acute high altitude exposure.MethodsThirty-six healthy adults were prospectively collected to undergo SE at low altitude(500 m)and high altitude(3600 m).Offline analysis was conducted to acquire resting and peak exercise ultrasound parameters at high and low altitudes:tricuspid regurgitant velocity(TRV),tricuspid annular peak systolic velocity(TV-s′),right ventricular end-diastolic area(RVEDA),right ventricular end-systolic area(RVESA),right ventricular fractional area change(RVFAC),right ventricular basal transverse dimension(RVD1),right ventricular mid-ventricular transverse dimension(RVD2),right ventricular longitudinal dimension(RVD3),right ventricular free wall longitudinal strain(RVFWS),right ventricular global longitudinal strain(RVGLS),left ventricular cardiac output(CO),pulmonary artery systolic pressure(PASP),mean pulmonary artery pressure(mPAP),pulmonary resistance(PVR)and the ratio of tricuspid annular systolic displacement(TAPSE)to PASP(TAPSE/PASP).The pulmonary vascular reserve and right ventricular systolic reserve indices including pulmonary vascular reserve and right ventricular systolic reserve indices(mPAP/CO) slope,change in tricuspid annular systolic displacement(ΔTAPSE),change in fractional area change(ΔRVFAC),change in overall long-axis strain of the right ventricle(ΔRVGLS),and change in peak velocity of the lateral wall of the tricuspid annulus(ΔTV-s′)were calculated.The differences of these parameters betweet high and low altitudes were compared.ResultsDuring the resting period,the values of TRV,PASP,mPAP,PVR,RVD2,and RVD3 were higher at high altitude than at low altitude(all P<0.05).TAPSE/PASP,RVFAC,RVGLS,and RVFWS were lower at high altitude than at low altitude(al

关 键 词：运动负荷超声心动图 右心室收缩 储备 高海拔地区 

分 类 号：R540.45[医药卫生—心血管疾病]