肺动脉高压的诊断和评估

Diagnosis and evaluation of pulmonary hypertension

肺动脉高压（pulmonary hypertension，PH）评估的目的是确定疾病的严重程度、血液动力学病变的本质和后果、病因诊断及伴随的症状。对有临床症状和胸部X线提示PH表现者，要详细地询问病史和细致的体检，而对病因和严重程度的评估可通过超声心动图、能气／血流扫描、胸部CT、肺功能检查、夜间血氧监测来完成。对超声心动图显示中度至严重PH和准备实施治疗者，要进行右心导管插管测定肺动脉压力。对处于发生PH危险因素的患者，要给予超声心动和肺功能检查，从而对PH的发展和预后进行评估。不推荐用基因检测对原发性PH常规评估。

The goals of evaluating pulmonary hypertension（PH） are detection,definition of severity and the nature of the hemodynamic lesion and its consequences,diagnosis of causal or associated conditions, and determination of optimal theray. In the patients with symptoms or chest radiographic findings suggestive of PH, a detailed history and physical examination followed by early assessment with a transthoracic echocardiogram,ventilation-perfusion scanning,chest computed tomography,pulmonary function testing,and nocturnal oximetry screening can provide valuable information about etiology and severity. Right heart catheterization should follow in the patients who are symptomatic or who demonstrate moderate to severe PH by echocardiography and are candidates for treatment. The patients at risk for developing PH should undergo serial echocardiography and pulmonary function test to assess disease development and progression. Genetic test is not currently recommended in the routine evaluation of patients with a diagnosis of primary PH.