心肺联合超声对合并或不合并肺水肿左心衰竭患者的比较研究

Comparative study in left heart failure patients with or without pulmonary edema cardiopulmonary ultrasound

目的通过心肺联合超声比较研究合并及不合并肺水肿的左心衰竭患者的临床及超声心动图参数。方法收集左心衰竭患者113例，超声心动图记录患者左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（I。VEF）、左房容积指数（LAVI）、肺动脉收缩压（SPAP）、二尖瓣反流程度、二尖瓣舒张期E峰和A峰、二尖瓣环e’，并计算平均E／e’。同时记录患者的NYHA心功能分级和血清氨基端脑钠肽前体（NT—proBNP）。肺超声将心衰患者分为合并肺水肿组和不合并肺水肿组，比较两组患者以上参数的差异。结果113例左心衰竭患者中，肺超声显示合并肺水肿患者72例（63．7％）。与不合并肺水肿组相比，合并肺水肿组NT—proBNP、LVEDD、LAVl、平均E／e’、右室基底横径、SPAP增高，LVEF减低，NYHA心功能分级、二尖瓣反流程度及舒张功能障碍更重（均P〈0．05）。多因素Logistic回归分析显示平均E／e’、SPAP、NTproBNP是心衰患者合并肺水肿的独立危险因素。结论心肺联合超声能够同时评价心衰患者心脏与肺部状况，左室舒张功能是左心衰患者合并肺水肿的重要决定因素。

Objective To compare the clinical and echocardiographic parameters in left heart failure patients with or without pulmonary edema by cardiopulmonary ultrasound. Methods All patients underwent transthoracic lung ultrasonography and echocardiography examination. The following echocardiographie parameters were determined： left ventrieular end-diastolic and end-systolic diameters （LVEDD and LVESD）,left ventricular end-diastolic and end-systolic volumes （LVEDV and LVESV）, left ventricular ejection fraction （LVEF）, left atrial volume index （LAVina^x）, systolic pulmonary artery pressure （SPAP） and the degree of mitral regurgitation, the peak Doppler velocities of early （E） and late （A） diastolic flow, early （e＇） diastolic velocity of the mitral annulus, and the average E/er ratio was calculated. The NYHA functional classification and N-terminal pro B type natriuretic peptide （NT-proBNP） were also recorded. Results A total of 113 heart failure patients, included 72 patients （63.7%） combined with pulmonary edema revealed by lung ultrasonography. Compared with patients without pulmonary edema, those with pulmonary edema were with higher plasma concentrations of NT-proBNP, NYHA functional class, left ventricular diastolic function classification, SPAP and E/er, larger LVEDD and the diameter of right ventricle, more severe mitral regurgitation, and lower LVEF（all P 〈 0.05）. By multivariate logistic regression analysis, E/er, SPAP and NT-proBNP were independent echocardiographic predictors of pulmonary edema in patients with heart failure. Conclusions Cardiopulmonary ultrasound can evaluate heart and pulmonary condition in patients with heart failure. Left ventricular diastolic function is an important determinant of pulmonary edema in patients with left heart failure.