超声心动图法测定肺动脉收缩压的可靠性和存在问题

Reliability and problems of Doppler echocardiography in assessing the pulmonary systolic pressure

目的 与有创的导管法对照 ,评价多普勒超声心动图法测定肺动脉高压患者肺动脉收缩压的可靠性和存在的问题 .方法 临床诊断为原发性肺动脉高压患者 73例 ,右心导管法实时监测右房、室压及肺动脉压 ,同时进行超声多普勒检查 ,测量三尖瓣最大返流速度 ,计算右房、室间压差 (Δp) ,并与心导管法测量结果进行相关性分析 .注意分析超声心动图法测定过程中出现的问题并讨论解决方法 .结果 多普勒超声心动图法测定的 Δp与导管法测定结果无显著差别 [(12 .6± 3.2 ) k Pa vs(12 .2± 3.1) k Pa,P>0 .0 5 ].两种方法测定的 Δp呈显著正相关 (r=0 .85 ,P<0 .0 1) .结论 多普勒超声心动图测压法可提供可靠的最大三尖瓣跨瓣压 ,与心导管法所测者相关显著 ,可为患者临床药物治疗及病情分析提供宝贵的血流动力学资料 ,但使用过程中需要注意影响测定准确性的技术因素以得到可靠结果 .

AIM To evaluate the reliability of Doppler echocardiography in assessing pulmonary systolic pressure and analyze the problems compared with the right heart catheterization. METHODS Seventy three patients were clinically diagnosed as with primary pulmonary hypertension (PPH) underwent right heart catheterization and Doppler echocardiography to measure the maximal systolic pressure gradient between the right ventricle and right atrium (Δ p ). The data from Doppler echocardiography and catheterization were compared. Problems in the Doppler measurement and corresponding methods were analyzed at the same time. RESULTS There was no significant difference in Δ p between the data obtained from Doppler echocardiography and that from catheterization [(12.6±3.2) kPa vs (12.2±3.1) kPa, P >0.05]. Good correlation existed between the two methods ( r =0.85, P <0.01). CONCLUSION Doppler echocardiography may provide with reliable pressure difference across the tricuspid valve, which has high positive correlation with the data obtained from the right heart catheterization. It may also provide precious hemodynamic information for the evaluation of therapy effects and the condition of the patients. Close attention should be paid to technical factors affecting the accuracy of measurement and to obtaining reliable data.