血压对Valsalva动作反应在肺动脉高压中的应用

The importance of blood pressure response to Valsalva maneuver in patients with puhnonary hypertension

目的 用简单床边体查鉴别肺动脉高压病理生理学.方法 2007年3月至2009年6月间宾西法尼亚大学心脏中心肺动脉高压患者做Valsalva动作.根据血压对Valsalva动作反应的不同分为正常组（valsalva动作开始到袖带法测量血压声音消失间期≤3次心跳）和不正常组（Valsalva动作开始到袖带法测量血压声音消失间期＞3次心跳）.血流动力学是肺动脉高压评价金指标.结果 本研究84例患者平均年龄（63±16）岁,血压对Valsalva动作反应不正常组有较高的肺动脉锲压[（22.5±6.6）vs.（11.9±4.3） mmHg（1 mmHg=0.133 kPa）,P＜0.01]和较低的肺血管阻力[（5.8±4.0）vs.（8.1±4.6）WU,P＜0.01].血压对Valsalva动作反应与平均肺动脉压[（46.2±9.69）vs.（43.4±10.4）mmHg,P＞0.05]和心排指数[（2.4±0.6）vs.（2.4±0.6）L/（min·m^2）,P＞0.05]无关.用血压对Valsalva动作反应不正常来判断肺动脉锲压＞15 mmHg的敏感度、特异度、准确性分别是89.4%、86.1%、86.9%.结论 在肺动脉高压患者人群中,血压对Valsalva动作反应不正常代表左心充盈压增高.

Objective To use a simple bedside technique to verify the pathophysiological mechanism of pulmonary hypertension （PH） in different races. Method The Valsalva maneuver （VM） was performed in patients referred to a specialty PH clinic. The blood pressure response of patients to VM was in different fashions. The blood pressure （BP） was measured by using cuff and stethoscope. When the cuff was inflated to 15 mmHg above the systolic pressure, sound could be heard by auscultation during VM and when the cuff was deflated the sound disappeared over 3 heart beats which was considered as abnormal BP response, and less than 3 heart beats defined as normal BP response. The right heart catheterization in patients with PH as a part of the standard evaluation. Results This study included 84 patients with a mean age of （63 ± 16） years. Those with abnormal BP response to VM had higher pulmonary artery wedge pressure （PAWP） [（22.5±6.6） vs. （11.9±4.3） mmHg, P 〈0.0001] and lower pulmonary vascular resistance [（5.8 ± 4.0） vs. （8.1 ± 4.6 ） WU, P = 0.01]. Blood pressure response to VM did not correlate with mean pulmonary artery （PA） pressure [（46.2 ± 9.9） vs. （43.4 ±10.4） mmHg, P =0.20] or cardiac index （both 2.4 ± 0.6 L/min/m^2）. The abnormal BP response to VM had high sensitivity （89.4%）, specificity （86.1%） and accuracy （86.9%） for determining PAWP〉 15 mmHg.Conclusions BP response to Valsalva maneuver provides important information about left heart filling pressures in patients with PH.