BTDE在ICU评价瓣膜置换术后PASP的准确性

The accuracy of BTDE for PASP after cardiac valve replacement in ICU

目的评价床边经胸多普勒超声心动图(BTDE)在重症监护室(ICU)对心脏瓣膜置换术后患者估测肺动脉收缩压(PASP)的准确性。方法 72例心脏瓣膜病需手术换瓣患者,术前放置右心导管,术后48 h内在ICU同时接受BTDE和右心导管对PASP评价。将BTDE估测的PASP与右心导管法实时监测PASP结果进行相关性分析。结果在72例受试对象中,主动脉瓣置换术后12例,二尖瓣置换术后38例,双瓣置换术后22例。两种方法所得PASP按主动脉瓣置换术后(A组)、二尖瓣置换术后(B组)及双瓣置换术后(C组)分组进行t检验,两种方法对3组中测定PASP差异均无统计学意义。Pearson相关性分析显示两种方法对3组所受试患者测量的PASP呈中度相关。BTDE与右心导管测量PASP差值在1.3 kPa以上者31例(43.0%),BTDE低于右心导管测量者22例(30.5%),高于右心导管测量者9例(12.5%)。结论 BTDE在ICU对于心脏瓣膜置换术后患者可快速提供可靠的PASP资料。

Objective To evaluate the accuracy of bedside transthoracic Doppler echocardiography （BTDE）vs right-heart catheterization in detecting pulmonary artery systolic pressure（PASP） in ICU patients who have already received heart valve replacement surgery. Methods We enrolled 72 patients with valvular diseases who were avail- able for a heart valve replacement surgery. A right cardiac catheter was placed before surgery. 48 hours after the surgery, PASP was measured directly through right cardiac catheterization or indirectly, by calculation according to tricuspid maximum reverse flow velocity measured by BTDE. Results 72 patients were devided into three groups： 12 with aortic valve replacement （ Group A）, 38 with valve replacement （Group C）. There were no statistical mitral valve replacement （Group B） and 22 with double significance in all three groups. The PASP estimated from BTDE was positively correlated with the PASP measured by right cardiac catheterization. PASP measurements ob- tained by BTDE were correlated with those obtained through right cardiac catheterization： the correlation coefficients in Group A, B and C. In 31 （43.0%） cases, the gratitude between BTDE-estimated PASP and right cardiac cathe- terization-measured PASP exceeded 1.3 kPa. In 22 （30. 5% ） out of these 31 cases, BTDE-estimated PASP excee- ded right cardiac catheterization-measured PASP and 9 （ 12.5% ） vice versa. Conclusion BTDE may provide re- liable estimated PASP values comparing with those generated by right cardiac catheterization.