解剖M型超声评价室间隔缺损患者肺血管阻力的初步研究

Anatomic M-mode echocardiographic evaluation for pulmonary vascular resistance in patients with ventricular septal defect

目的:探讨解剖M型超声(AMM)对分析室间隔缺损(VSD)患者肺动脉机械特征及评价肺血管阻力(PVR)的价值。方法:应用AMM观测20例轻症VSD患者、18例重症VSD患者及20例正常人的主肺动脉运动曲线,测量主肺动脉短轴缩短率(PAFS)、主肺动脉外侧壁搏动幅度(PAWPA)、外侧壁快速扩张速率(R-DVR)及外侧壁快速缩短速率(R-CVR)。应用VSD跨隔压差结合肱动脉压计算出肺动脉收缩压,应用肺动脉血流时间间期法计算出PVR值。结果:VSD轻症组及重症组的PAFS、PAWPA、R-DVR及R-CVR均低于对照组,且重症组上述参数的减小幅度更显著(P<0.05)。结论:AMM可无创评价肺动脉的力学特性,PAFS及PAWPA等参数可作为半定量评价VSD患者PVR的超声指标。

Objective：To explore the utility of anatomic M-mode echocardiographie （AMM） evaluation for pulmonary arterial mechanical characteristics and its relation to the severity of the increased pulmonary vascular resistance （PVR） in patients with ventricular septal defect （VSD）. Methods： Routine echocardiography and AMM examination were performed on 20 healthy individuals and 38 patients with VSD who were divided into two groups according to the severity of PVR： patients with mild VSD （n = 20） and patients with severe VSD （n = 18）. Pulmonary artery fraction shortening （PAFS）, pulsating amplitude of pulmonary artery wall （PAWPA）, rapid distending velocity rate（R-DVR）and rapid contracting velocity rate （R-CVR） were measured during AMM examination. Pulmonary artery systolic pressure and PVR were calculated using appropriate formulas. Results：compared with the control group, the PAFS, PAWPA, R-DVR and R-CVR were significantly lower in the mild VSD group and the severe VSD group. The mean of each parameter in the mild VSD group was statistically lower than that in the severe VSD group. Conclusions：AMM provides a noninvasive means of revealing pulmonary arterial mechanical characteristics. PAFS, PAWPA, R-DVR and R-CVR may represent several indices for semi-quantitative assessment of PVR.