小儿扩张型心肌病肺动脉压的多普勒超声估测及其临床意义

Doppler echocardiographic assessment of the pulmonary arterial pressure in children with dilated cardiomyopathy and its clinical implications

目的估测扩张型心肌病肺动脉压并探讨其临床意义。方法用多普勒超声检查２６例扩张型心肌病患儿及２６名配对健康儿。肺动脉压用测三尖瓣最大返流速度及肺动脉血流加速时间（ＡＴ）两种方法估测。结果２６例患儿中２１例有三尖瓣返流，肺动脉收缩压（ＰＡＳＰ）３．２～１０．４ｋＰａ（６．０±１．９ｋＰａ）（２４～７５ｍｍＨｇ，１ｋＰａ＝７．５ｍｍＨｇ）。其中１８例（８６％）＞４ｋＰａ；对照组１４例有可测三尖瓣返流，ＰＡＳＰ均＜４ｋＰａ。患儿组ＡＴ缩短，ＡＴ与右室射血时间比值降低，也提示肺动脉压增高。ＰＡＳＰ与患儿左室短轴缩短分数、心功能低下持续时间及有无心内超声自发显影有关。随诊显示心功能好转者的ＰＡＳＰ较死亡或病情无改善者低，且后者肺动脉压继续增高。结论扩张型心肌病患儿多存在肺动脉高压，用多普勒超声估测的肺动脉压与患儿的病情及临床预后可能有一定的关系。

Objective To assess the pulmonary arterial pressure in children with dilated cardiomyopathy (DCM) and to analyse its clinical implications. Methods Twenty six children with DCM (13 male, 13 female; aged 1 — 14 years) and 26 age and gender matched normal controls were studied with Doppler echocardiography. The pulmonary pressure was assessed with two methods: (1) measuring the maximal regurgitant velocity of the tricuspid valves; (2) measuring the acceleration time (AT) and right ventricular ejection time (RVET) of the pulmonary flow. Results Out of 26 patients, 21 had tricuspid regurgitation, with a pulmonary systolic pressure (PASP) of 3.2～10.4 kPa (6.0± 1.9 kPa). PASP was higher than 4 kPa in 18 (86%) cases. Only 14 of the 26 controls had tricuspid regurgitation, with a PASP< 4 kPa in all of them. AT was shortened and AT/RVET decreased in the patients with DCM, indicating an elevaled pulmonary arlery pressure. PASP was related to the left ventricular fraction shortening, the persisting time of cardiac dysfunction and whether or not the patients had spontaneous echo contrast. PASP was significantly lower in patients who had improved cardiac function during the follow up, and increased in patients whose cardiac function did not improve. Conclusion Most of the children with DCM had an elevated PASP. PASP estimated by Doppler echocardiography probably related to the severity of the disease and might be an useful indicator to predict the clinical prognosis.