用放射性核素检测慢性肺心病患者的右心功能

THE EXAMINATION OF RIGHT HEART FUNCTION IN CHRONIC COR PULMONALE BY RADIONUCLIDE VENTRICULOGRAPHY

８０例慢性阻塞性肺疾病、肺心病患者和２０例无心肺疾病对照者，用ｒ照相机测定其右室射血分数（ＲＶＥＦ），于８０例患者中选择３０例肺心病患者行ＳｗａｎＧａｎｚ导管检查，以测量肺动脉压等参数。结果：对照组（２０例）、慢性支气管炎肺气肿组（２０例）、肺心病心功能代偿组（３０例）、肺心病右心衰竭组（３０例）４组间ＲＶＥＦ分别为０．４２、０．３７、０．３３、０．２６，均有显著性差异。肺动脉平均压与ＲＶＥＦ呈显著负相关（ｒ＝－０．６１，Ｐ＜００１）；若以ＲＶＥＦ≤０３３为预计肺动脉高压的界值，阳性预计准确性为８２％，阴性预计准确性为６２％。提示放射性核素检测ＲＶＥＦ可能是无创诊断慢性阻塞性肺疾病患者有无肺动脉高压及早期判断其右心功能状况的一种较好方法。

Noninvasive measurements of RVEF by radionuclide ventriculography were performed in 20 control subjects, 80 patients with COPD and cor pulmonale. Simultaneous right heart catherizations were performed in 30 patients with cor pulmonale to determine the mean pulmonary artery pressure(mPAP). Results: The RVEFs in control subjects, COPD, cor pulmonale, cor pulmonale with right heart failure were 0.42, 0.37, 0.33, 0.26 respectively. The mean RVEFs were different significantly among the groups. With the development of the diseases, the RVEFs reduced gradually. The examination of RVEF was more valuable than the examinations of chest roentgenography, electrocardiography and echocardiography in the diagnosis of cor pulmonale. The mPAP correlated negatively to RVEF(r=-0.61, P<0.01). So, the measurement of RVEF by radionuclide ventriculography was regarded as reliable. We conclude the measurement of RVEF by radionuclide ventriculography may be an effective method in the diagnosis of pulmonary hypertension and right heart function of chronic cor pulmonale.