超声心动图评估稳定期慢性阻塞性肺疾病患者右心功能的价值

Echocardiographic evaluation of right heart function in patients with stable chronic obstructive pulmonary disease

目的 :应用美国超声心动图学会推荐的右心功能超声指标评估稳定期慢性阻塞性肺疾病的右心功能,并寻找一个可靠敏感指标运用于常规检查中。方法:64例轻中度慢性阻塞性肺疾病患者,按照严重程度分为肺功能Ⅱ级29例,Ⅲ级35例;另选择33例同期健康体检者作为对照组,3组无年龄及性别差异。测量3组19项指标,探讨慢性阻塞性肺疾病Ⅱ级、Ⅲ级同健康成人之间的差异性。结果:右室流出道(RVOT)近端内径对照组(29.08±2.12)mm,肺功能Ⅱ级(31.04±2.95)mm,Ⅲ级(32.00±3.45)mm,对照组与肺功能Ⅱ、Ⅲ级比较差异均有统计学意义(均P<0.05);右室基底径对照组(31.15±4.83)mm,肺功能Ⅱ级(33.86±3.75)mm,Ⅲ级(34.06±4.41)mm,对照组与肺功能Ⅱ、Ⅲ级比较差异均有统计学意义(均P<0.05);右室壁厚度对照组(4.53±0.50)mm,肺功能Ⅱ级(5.15±1.07)mm,Ⅲ级(5.27±0.91)mm,对照组与肺功能Ⅱ、Ⅲ级比较差异均有统计学意义(均P<0.05);下腔静脉塌陷率对照组(56.23±4.23)%,肺功能Ⅱ级(31.51±10.13)%,Ⅲ级(28.25±11.01)%,对照组与肺功能Ⅱ、Ⅲ级比较差异均有统计学意义(均P<0.05);组织多普勒三尖瓣侧壁部瓣环收缩期峰值流速(S’)对照组(10.74±1.08)cm·s-1,肺功能Ⅱ级(9.62±1.37)cm·s-1,Ⅲ级(9.24±0.91)cm·s-1,对照组与肺功能Ⅱ、Ⅲ级比较差异均有统计学意义(均P<0.05);3组间E/A、Tei指数差异均有统计学意义(对照组1.53±0.25、肺功能Ⅱ级0.93±0.28、Ⅲ级0.65±0.20;对照组0.46±0.14、肺功能Ⅱ级0.54±0.87、Ⅲ级0.63±0.14;均P<0.05)。结论 :随着肺功能的恶化,右心功能减低,Tei指数和S’能够较敏感地反映右心功能。

Objective：To evaluate the right ventricular （ RV ） function in patients with stable chronic obstructive pulmonary disease （COPD） using the parameters recommended by the American Society of Echocardiography （ASE）,and try to find out sensitive parameters in clinical practice. Methods：A total of 64 patients with stable COPD were selected and staged by pul-monary function test （PFT）,of which 29 were in stage Ⅱ,35 were in stage Ⅲ. And 33 healthy volunteers with age and gender matched were as controls. Routine transthoracic echocardiography study was performed on all patients and 19 parameters were measured in order to compare the differences of the parameters among the three groups. Results：RVOT PLAX proximal di-ameter,RV basal diameter,end-diastolic RV wall thickness,S’ of control group had significant differences than that of stage Ⅱand Ⅲ [（29.08±2.12）mm vs. （31.04±2.95）mm and （32.00±3.45）mm,P〈0.05;（31.15±4.83）mm vs. （33.86±3.75）mm and （34.06±4.41）mm,P〈0.05;（4.53±0.50）mm vs. （5.15±1.07）mm and （5.27±0.91）mm,P〈0.05;（10.74±1.08）cm·s^-1 vs. （9.62± 1.37）cm·s^-1 and （9.24±0.91）,respectively,P〈0.05]. IVC diameter collapse in control group was significantly lower than that in stage Ⅱ and Ⅲ [（56.23±4.23）% vs. （31.51±10.13）% and （28.25±11.01）%,respectively,all P〈0.05]. E/A,Tei in the three groups were significantly different [（1.53±0.25）,（0.93±0.28） and （0.65±0.20）;（0.46±0.14）,（0.54±0.87） and （0.63±0.14）,respective-ly,all P〈0.05]. Conclusions：With the deterioration of lung function in COPD patients,the right heart function getting worse and worse. Tei and S’ are sensitive parameters for clinical practice.