多普勒超声心动图对原因不明心脏收缩期杂音的诊断价值

The diagnostic value of cardiac systolic murmurs of unknown cause by Doppler echocardiography

目的 探讨多普勒超声心动图技术判定原因不明心脏收缩期杂音性质的价值。方法 选择门诊初诊的原因不明心脏杂音的患者 16 0例 ,年龄 14～ 86 (5 6± 2 4)岁 ,分析比较心内科医师进行临床心脏检查 (无临床病史、心电图及 X线资料参考 )和超声心动图检查判定心脏杂音性质的准确性。结果 超声心动诊断功能性杂音 38例 ,器质性杂音 12 2例 ,以主动脉和二尖瓣复合病变最常见 ;其中主动脉瓣狭窄 (AS) 38例 ,主动脉瓣反流 (AR) 32例 ,二尖瓣反流 (MR) 4 5例 ,三尖瓣反流 (TR) 2 8例 ,二尖瓣脱垂 (MVP) 15例 ,室间隔缺损 (VSD) 12例 ,另外有 19例患者可记录到收缩晚期室内峰值压差。临床心脏检查确定功能性杂音、AS、AR、MR、TR、MVP、VSD及室内峰值压差的敏感性依次为 6 6 %、73%、2 2 %、72 %、6 0 %、5 6 %、98%及 2 1% ,与孤立性瓣膜病变比较 ,复合瓣膜病变时临床诊断的敏感性最差 (P<0 .0 0 1)。有 16例临床及超声心动图心脏检查不符。结论 临床心脏检查确定杂音性质有局限性 ,特别是在一个以上部位瓣膜病变时 。

Objective To assess the value of Doppler echcardiography in evaluation of systolic murmurs of unknown cause.Methods 160 outpatients with systolic murmur of unknown cause,aged 14 to 84,were examined by cardiologists.The diagnostic accuracy of the cardiac examination by cardiologists (without reference of clinical history,electrocardiogram and chest radiograph) was compard with the results of echocardiography.Results The echocardiographic findings included a function murmurs in 38 patients and organic murmurs in 122 patients.Combined aortic and mitral valve disease was the most frequent combination,in which aortic stenosis (AS) in 38 patients,aortic regurgitation (AR) in 32 patients,mitral regurgitation (MR) in 45 patients,tricuspid regurgitation (TR) in 28 patients, mitral valve prolase(MVP) in 15 patients, ventricular septal defect (VSD) in 12 patients and intraventricular pressure gradients in 19 patients.The sensitivity of the clinic cardiac examination for detecting AS,AR,MR,TR,MVP,VSD and intraventricular pressure gradients were 66%?73%?22%?72%?60%?56%?98% and 21%,respectively.The diagnostic sensitivity of clinical examination for combined aortic and mitral valve disease was poor in comparison with isolated valvular lesion (P<0.001).There was considerable discrepancy between the results of the cardiac examination and the finding of echocardiography in 16 patients. Conclusion The ability of the clinical cardiac examination to assess the exact cause of the murmurs is limited,especially if more than one lesion is preent .And echocardiography can provide a definite diagnosis in evaluation of systolic murmurs of unknown cause.