尘肺病患者超声心动图肺循环血流动力学指标分析

Analysis on pulmonary hemodynamic parameters in pneumoconiosis patients by echocardiography

目的探讨超声心动图检测的肺循环血流动力学指标在尘肺病患者中的变化及其临床价值。方法采用单纯随机抽样方法,选取102例男性尘肺病患者,根据患者有无合并慢性肺源性心脏病(以下简称"肺心病")分为单纯尘肺病组(70例)和尘肺病合并肺心病组(32例),同时选择健康男性志愿者作为对照组(40人)。采用超声心动图测量研究对象的肺动脉主干内径(MPA)、右室流出道内径(RVOT)、右室内径(RV)、三尖瓣返流峰值速度和右室流出道血流速度时间积分,估算右心房压力,计算肺动脉收缩压(PASP)、肺血管阻力(PVR)和肺动脉血流加速时间与右室射血时间(PAAT/RVET)比值。结果尘肺病合并肺心病组患者MPA、RVOT、RV分别宽于对照组和单纯尘肺病组(P<0.05),单纯尘肺病组患者RVOT宽于对照组(P<0.05)。尘肺病合并肺心病组患者PASP、PVR分别高于对照组和单纯尘肺病组(P<0.05),单纯尘肺病组患者PASP和PVR分别高于对照组(P<0.05)。尘肺病合并肺心病组和单纯尘肺病组患者PAAT/RVET比值分别低于对照组(P<0.05)。单纯尘肺病组患者MPA和RV分别与对照组比较,差异均无统计学意义(P>0.05)。结论应用超声心动图监测尘肺病患者肺循环血流动力学指标,可为临床制定早期干预措施提供依据。

Objective To explore the changes of pulmonary hemodynamic parameters in pneumoconiosis patients examined by echocardiography and its clinical significance. Methods Using simple random sampling method, 102 male patients with pneumoconiosis were chosen and divided into simple pneumoconiosis group （70 cases） and pneumoconiosis combined with chronic pulmonary heart disease （CPHD） group （32 cases）. Forty healthy male volunteers were chosen as the control group. The right heart morphological indexes including the diameters of main puhnonary artery （ MPA ）, right ventricular outflow tract （RVOT）, right ventricle （RV）, the tricuspid regurgitation velocity and the time velocity integral of the right ventricular outflow tract were measured with echocardiography. The right atrial pressure was estimated and the pulmonary artery systolic pressure （PASP）, the pulmonary vascular resistance （PVR） and the ratio of pulmonary artery acceleration time/right ventricular ejection time （PAAT/RVET） were calculated. Results The diameters of MPA, RVOT and RV in pneumoconiosis combined CPHD group were longer than those of the control group and simple pneumoconiosis group （ P 〈 0. 05）. The RVOT diameter of simple pneumoconiosis group was longer than that of the control group （P 〈 0. 05 ）. The indexes of PASP and PVR in pneumoconlosis combined CPHD group were higher than those of the control group and simple pneumoconiosis group, respectively （ P 〈 0. 05 ）. The indexes of PASP and PVR in simple pneumoconiosis group were higher than those of the control group （ P 〈 0. 05 ）. The indexes of PAAT/RVET in pneumoconiosis combined CPHD group and simple pneumoconiosis group were lower than that of the control group, respectively （P 〈 0. 05 ）. There was no statistical significance difference found in MPA and RV diameters between simple pneumoconiosis group and the control group （P〉 0. 05 ）. Conclusion Our results indicate that monitoring the pulmonary hemodynamic parameters of pneumoconiosis patients by using eehocardiography can provide basis for planning early intervention measures in clinic.