超声心动图对评价肺移植围手术期心脏构型、血流动力学及功能的价值

Value of the association of perioperative cardiac configuration,function and hemodynamic alterations in lung transplantation by echocardiography

目的探讨超声心动图在评价肺移植围手术期心脏构型、血流动力学及功能变化中的价值。方法回顾性对比分析52例同种异体肺移植患者术前与术后（3~7 d）超声心动图检测数据。包括1心脏构型：左房内径（LAD）、右房内径（RAD）、左室舒张末内径（LVEDD）、右室舒张末内径（RVED）、室间隔厚度（IVS）、左室后壁厚度（LVPW）、肺动脉内径（PAD）;2血流动力学及心功能：三尖瓣反流面积（TR）、肺动脉收缩压（PASP）、二尖瓣口血流频谱E波、A波比值（E/A）、左室射血分数（LVEF）;3心脏并发症：心包积液（PE）等。结果肺移植术后患者心脏变化。显示,1心脏构型的变化：肺移植术后RAD、RVED、PAD较术前缩小（P〈0.05）,LAD、LVEDD较术前扩大（P〈0.05）,而LVS、LVPW变化差值无统计学意义;2血流动力学及心功能：术后PASP下降,E/A增高,LVEF下降,差异均具有统计学意义（P〈0.05）;3并发症：2例患者术前少量心包积液,术后1例消失,1例减少,术后未发现患者有新发心包积液。结论超声心动图检测可有效地评估肺移植术后心脏结构与功能尤其是肺动脉压的变化,在术后早期可有效监测肺动脉压的改善情况以及左室收缩功能指标（LVEF）的变化趋势,具有良好的临床指导意义。

Objective To explore the application of perioperative cardiac configuration,function and hemodynamic alterations in lung transplantation by echocardiography. Methods A total of 52 cases of lung transplant recipients were included in the study, their preoperative and postoperative（ 3-7days）echocardiography data were reviewed. 1Configuration ： the end diastolic diameter of the atria and the ventricles（ LAD,RAD,LVEDD and RVED）,the thickness of interventricular septum and left ventricular posterior wall（ IVS and LVPW）,the diameter of pulmonary artery（ PAD）; 2Hemodynamics and cardiac function ： area of tricuspid regurgitation（ TR）,pulmonary artery systolic pressure（ PASP）,ventricular early and late diastolic filling peak velocities（ E, A and E / A）, and left ventricular ejection fraction（ LVEF）; 3 Cardiac complications： pericardial effusion（ PE）. Results After lung transplantation in patients with heart changes as follows： 1 Configuration： RAD, RVED, PAD zoomed down after lung transplantation compared with preoperative,but LAD,LVEDD were enlarged,those differences above were statistically significant（ P 〈0. 05）. The differences of IVS and LVPW showed no statistical significance; 2 Hemodynamics and cardiac function： PASP decreased significantly compared with preoperative, E / A was increased and LVEF wasdecreased,those differences above were statistically significant（ P 〈 0. 05）; 3Cardiac complications： 2 cases were detected with small PE preoperative,1 case disappeared and 1 case redused postoperative. No new cases had found following the transplantation. Conclusions Echocardiography can effectively assess cardiac structure and function after lung transplantation,especially the change of the PASP. The improvement of PASP and the change trend of LVEF have a good clinical significance for early lung transplant patients.