双平面经食管超声观察肺静脉血流估测肺毛细血管楔嵌压

Estimation of Mean Pulmonary Capillary Wedge Pressure from Transesophageal Pulsed Echocardiography of Pulmonary Venous Flow

应用双平面经食管超声观察肺静脉血流（ＰＶＦ）估测肺毛细血管楔嵌压，共研究了２０例风湿性心脏病人的肺静脉血流特征，并与心导管检查测得的平均肺毛细血管楔嵌压（ＭＰＣＷＰ）进行相关比较分析。结果：风心病以二尖瓣狭窄为主要病变患者的ＰＶＦ参数中，收缩分数（ＳＦ）与ＭＰＣＷＰ相关性最好（ＭＰＣＷＰ＝３４．０８－０．４０×ＳＦ，ＳＥＥ＝２．８９ｍｍＨｇ，ｒ＝－０．８８，Ｐ值＜０．０１），且多元逐步回归表明：二尖瓣环下降（ＤＯＢ）、左房舒张率（ＥＩ）、左室短轴缩短率（ＦＳ）及血压（ＳＢＰ、ＤＢＰ）、心率（ＨＲ）、年龄（Ａｇｅ）等因素均不明显影响之。结论：ＳＦ是估测风心病二窄为主要病变患者ＭＰＣＷＰ的较好指标。

To determine whether variables of pulmonary venous flow (PVF) measured by transesophageal echocardiography could be used to estimate mean capillary wedge pressure(MPCWP). Methods: Twenty consecutive patietns with almost pure rheumatic mitral valve stenosis were prospectively examined and the Doppler variables of PVF were correlated with MPCWP measured by cardiaccatheterization. Results: Among the variables of PVF in patients with almost pure rheumatic mitrial valve stenosis, the systolic fraction (SF) (i.e.,the systolic velocitytime integral expressed as a fraction of the sum of systolic and diastolic velocitytime integrals) correlated best with MPCWP (MPCWP=34.08-0.40×SF, SEE=2.89mmHg, r=-0.88,P<0.01). A multiple stepwise linear regression analysis showed that descent of mitral anulus, left atrial expansion, ventricule constraction, SBP, DBP,HR and Age did not significently influence this relationship. Conclusion: SF was better variable which could estimate MPCWP in patients with almost pure rheumatic mitral valve stenosis. This method offer a simple and reliable approach to noninvasive estimation of MPCWP.