二尖瓣狭窄患者的下腔静脉口脉冲多普勒超声心动图观察

Observation of Inferior Vena Caval Orifice Flow in Patients with Mitral Stenosis by Doppler Echocardiography

目的探讨二尖瓣狭窄（二狭）患者下腔静脉回流入右房状态。方法用彩色多普勒超声心动图对７４例二狭患者及３２例对照者沿胸骨右缘纵切探查下腔静脉口的最大内径及血流速度。结果对照组、二狭并轻度三尖瓣返流者（Ⅰ组）、二狭并中度三尖瓣返流者（Ⅱ组）及二狭并重度三尖瓣返流者（Ⅲ组）四组的下腔静脉口内径有显著差异（分别为２０．１±２．４ｍｍ、１７．０±５．９ｍｍ、１６．１±６．２ｍｍ及２７．８±１０．２ｍｍ）。但四组的下腔静脉口峰值血流速度及平均血流速度无明显的差别。简单线性相关分析发现二狭非重度三尖瓣返流者（Ⅰ组、Ⅱ组）的下腔静脉口内径与其峰值血流速度之间呈明显的负相关关系（ｒ＝－０．６２，Ｐ＜０．０１），且下腔静脉口内径与左房内径亦呈明显负相关关系（ｒ＝－０．７１，Ｐ＜０．０１）。

Objective To study the venous return from inferior vena caval orifice(IVCO) to right atrium in patients with mitral stenosis.Method The maximum dimension of the IVCO by two dimensonal echocardiography and the maximum IVCO flow velocity by pulsed wave Doppler echocardiography by transthoracic right parasternal view in the longitudinal plane were measured in 74 patients with mitral stenosis and 32 control subjects.Results There were siginificant differences among the IVCO dimensions of the control group(32 normal subjects),group Ⅰ(19 mitral stenosis patients with mild tricuspid regurgitation),group Ⅱ(20 mitral stenosis patients with moderate tricuspid regurgitation) and group Ⅲ(35 mitral stenosis patients with severe tricuspid regurgitation),their measured values were 20.1±2.4mm,17.0±5.9mm,16.1±6.2mm and 27.8±10.2mm,respectively.However,there were no significant differences in peak and mean IVCO flow velocities.There were significant negative correlations between the IVCO dimension and the peak IVCO flow velocity( r =-0.62, P <0.01),as well as the left atrial dimension( r =-0.71, P <0.01) in 39 mitral stenosis patients without severe tricuspid regurgitation.Conclusions The greater left atrium seen in patients with mitral stenosis may decrease venous return from the inferior vena cava.