肺血栓栓塞患者右心功能的临床研究

Clinical study on right ventricular function of pulmonary thromboembolism.

目的 利用彩色多普勒超声心动图观察肺血栓栓塞患者的右心功能。方法 应用超声心动图观察31例肺血栓栓塞患者（研究组）右心室壁运动及右心室收缩整体功能，并计算其右心功能指数，以31例同年龄组心血管疾病及其危险因素相似的志愿者为对照。结果 肺血栓栓塞患者右房室内径及右心室舒张末期容积、主肺及右肺动脉内径均大于对照组（P〈0．01）；右心室前壁运动幅度、右心室射血分数低于对照组（P〈0.01）。三尖瓣前向血流频谱显示，研究组早期充盈E峰减低，E／A比与对照组相比下降（P〈0.01）；研究组等容舒张期和等容收缩期延长，右心室射血期缩短，右心室心肌工作指数增大（P〈0．01），右心室心肌工作指数与右心室射血分数（r=0．78，P〈0．01）、等容舒张期和等容收缩期有高度相关性（r分别为0．88、0．57，均P〈0．01）。结论 肺血栓栓塞患者右心舒缩功能下降，右心室心肌工作指数可较敏感反映这一变化。

Objective To study the right ventricular function of patients with pulmonary thromboembolism by using color Doppler ultrasound. Methods 31 patients with acute pulmonary thromboembolism, compared with 31 volunteers,were enrolled in this study. The right ventricular anterior wall movement, right ventricular end diastolic volume ,right ventricular ejection fraction, and myocardial performance index were observed by echocardiography. Re- stilts The right atrium diameter, right ventricles diameter,right ventricular end diastolic volume and pulmonary ar- tery inner diameter in study group were much larger than that in control group （ P 〈 0.01 ） , and the right ventricular anterior wall movement and right ventricular ejection fraction decreased in study group （ P 〈 0.01 ）. Tricuspidal annular E peak velocity tended to be decreased, isovolumic relaxation time and isovolumic contraction time were prolonged and myocardial performance index was increased （P 〈 0.01 ）. Right ventricular myocardial performance index showed significant correlation with right ventricular ejection fraction （ r = 0.78, P 〈 0.01 ） , isovolumic relaxation time and isovolumic contraction time （ r1 = 0.88 , r2 = 0.57, P 〈 0.01 ）. Conclusion The right ventricular function in patients with pulmonary thromboembolism is decreased and myocardial performance index is a sensitive index which can be used to reflect right ventricular function in pulmonary thromboembolism.