超声心动图评价房间隔缺损合并不同程度肺动脉收缩压患者右心室形态及收缩功能  

The Evaluation of Right Ventricular Morphology and Systolic Function in Patients with Atrial Septal Defect Combing with Different Pulmonary Artery Systolic Pressure by Echocardiography

作　　者：曹伟[1] 纳丽莎[1] 贾梅[1] 徐艳萍[1] 周丽[1] 余芳[1] 

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部,银川750004

出　　处：《宁夏医科大学学报》2016年第10期-,共6页Journal of Ningxia Medical University

摘　　要：目的应用超声心动图技术评价房间隔缺损(atrial septal defect,ASD)合并不同程度肺动脉收缩压(pulmonary artery systolic pressure,PASP)患者右心室形态及收缩功能的变化。方法选取57例单纯继发孔型ASD成人患者做为病例组(ASD组),根据三尖瓣返流速度估测的PASP,将病例组分为无肺动脉高压组(A组)、轻度肺动脉高压组(B组)及中重度肺动脉高压组(C组)。选取同期健康成人志愿者20例作为对照组。所有病例均行超声心动图检查,采用M型超声心动图、二维超声心动图、心肌组织多普勒成像技术对各组右心室相关参数进行测量及分析,并将所测的右心室收缩功能参数三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、右心室面积变化分数(right ventricle fractional area change,RVFAC)、组织多普勒三尖瓣收缩期峰值速度(tricuspid annular peak systolic velocity,TASa)与PASP做相关性分析。结果 A组右心室形态及收缩功能和对照组比较差异无统计学意义(P>0.05);B组与A组比较右心房、右心室增大,右心室舒张末期面积(right ventricular end-diastolic area,Area ED)、右心室收缩末期面积(right ventricular end-systolic area,Area ES)增加,TAPSE减低(P<0.05),且随着肺动脉高压的加重而呈进行性变化,C组患者右心室流出道及肺动脉内径开始增大,右心系统整体增大,RVFAC、TASa和对照组、A组、B组比较出现降低(P<0.05)。相关性分析提示RVFAC、TAPSE、TASa与PASP均呈负相关(r=-0.682、-0.695、-0.546,P均<0.01)。结论随着PASP的增高,ASD患者右心室形态学相关指标逐渐增大,右心室收缩功能减低。RVFAC、TAPSE、TASa能准确、有效评估ASD合并不同PASP患者右心室功能的受损程度,其值越小受损程度越严重。其中TAPSE的变化出现最早,与PASP的相关性最高,可早期评价右心室收缩功能的改变。Objective To evaluate the right ventricular morphology and systolic function in patients with atrial septal defect(ASD)combing with different pulmonary artery systolic pressure by echocardiography.Methods 57 cases with atrial septal defect were selected as ASD group,which were divided into without pulmonary hypertension(PH)group,mild PH group,moderate to severe PH group according to pulmonary artery systolic pressure(PASP),which was calculated through the three tricuspid regurgitation.At the same tine,twenty healthy adult volunteers were selected as the control group.All subjects undertaken M-Echo,Two-dimensional echocardiography,and TDI examination for measurement and analysis of related parameters of right ventricle.Correlation was analyzed between the parameters of right ventricle tricuspid annular plane systolic excursion(TAPSE),right ventricl fractional area change(RVFAC),tissue doppler tricuspid annular peak systolic velocity(TASa),and PASP,respectively.Results There was no statistically significant difference between the ASD without PH group and the control group in right ventricular morphology and systolic function(P>0.05).Right ventric,Right atrium,right ventricular end-diastolic area(Area ED),right ventricular end-systolic area(Area ES)in patients with mild PH were significantly larger than that in ASD without PH group(P<0.05),whereas TAPSE reduced significantly(P<0.05).All this progressively changed,with the increase of pulmonary hypertension,till moderate to severe PH group and right ventricular outflow tract and pulmonary artery diameter was expanding,right heart system as a whole to expand,and RVFAC,TASa were significantly lower in patients with moderate to severe PH group compared with other groups(P<0.05).RVFAC,TAPSE,TASa showed a significantly negative correlation with PASP(r=-0.682,-0.695,-0.546,P all<0.01).Conclusion With the increase of PASP,right ventricle related Morphology parameters in patients with ASD appeared to reduce gradually,but the right ventricular systolic function showed a decre

关 键 词：房间隔缺损 肺动脉高压 超声心动图 右心室收缩功能 

分 类 号：R540.45[医药卫生—心血管疾病] R541.1[医药卫生—内科学]