右室Tei指数对慢性阻塞性肺疾病患者右室功能的评价

Evaluation of right ventricular Tei index on right ventricular function of chronic obstructive pulmonary disease patients

目的探讨右室Tei指数评价慢性阻塞性肺疾病(COPD)患者右心室功能的临床应用价值。方法 127例COPD急性发作经住院治疗后缓解的患者作为观察组,根据我国的肺动脉高压判断标准将其分为肺动脉压力正常组(28例)、轻度肺动脉高压组(58例)、中、重度肺动脉高压组(41例);67例正常健康体检者作为对照组,通过多普勒超声心动图依次检测观察组患者急性期、缓解期以及病情好转稳定后1个月3个阶段的右室Tei指数以及肺动脉压力,并与对照组比较,检测各组研究对象的右室各项基础测量值和Tei指数。结果观察组患者急性期、缓解期及病情好转稳定后1个月右室Tei指数[(0.79±0.17)、(0.54±0.11)、(0.56±0.10)]以及肺动脉压力[(61.4±10.3)、(46.2±8.6)、(37.4±6.2)mm Hg(1 mm Hg=0.133 k Pa)]均显著高于对照组(0.33±0.09)、(19.7±4.6)mm Hg,差异均具有统计学意义(P<0.05)。观察组患者处于缓解期及病情好转稳定后1个月时的右室Tei指数以及肺动脉压力均低于急性期,差异均具有统计学意义(P<0.05)。轻度肺动脉高压组及中、重度肺动脉高压组的肺动脉压力、右室Tei指数高于对照组,差异均具有统计学意义(P<0.05或0.01);对照组的肺动脉主干、三尖瓣S峰、三尖瓣E峰均优于中、重度肺动脉高压组,差异均具有统计学意义(P<0.05);肺动脉压力正常组的右室Tei指数高于对照组,差异具有统计学意义(P<0.05)。结论右室Tei指数可较传统超声指标更敏感的反映COPD患者的病情严重程度和右心室功能,具有很好的临床应用价值。

Objective To explore the clinical application value of right ventricular Tei index in evaluation of right ventricular function of chronic obstructive pulmonary disease (COPD) patients. Methods There were 127 COPD acute attack patients who were relieved after hospitalization as observation group, and they were divided by pulmonary hypertension judgment standard into pulmonary artery pressure normal group (28 cases) and mild pulmonary hypertension group (58 cases), medium and severe pulmonary hypertension group (41 cases). 67normal health examination people as control group. Doppler echocardiography was used to successively detect right ventricular Tei index and pulmonary arterial pressure of acute phase, remission phase and 1 month after improved stability in patients of observation group, and the outcome was compared with the control group. Right ventricular basic measurements and right ventricular Tei indexes were detected in all groups. Results Theobservation group had higher right ventricular Tei index in acute stage, remission stage and 1 month after stabilityof disease[ (0.79±0.17), (0.54±0.11) and (0.56±0.10)] and pulmonary arterial pressure in three stages above[(61.4±10.3), (46.2±8.6) and (37.4±6.2) mm Hg (1 mm Hg=0.133 kPa)] than (0.33±0.09) and (19.7±4.6)mm Hg in the control group. All their difference had statistical significance (P<0.05). The observation group hadlower right ventricular Tei index and pulmonary arterial pressure in remission phase and 1 month after improvedstability than acute phase, and their differences had statistical significance (P<0.05). Mild pulmonary hypertension group and medium and severe pulmonary hypertension group had higher right ventricular Tei index and pulmonary arterial pressure than the control group, and their differences had statistical significance (P<0.05 or 0.01). The control group had better pulmonary artery trunk, tricuspid valve S peak and tricuspid valve E peak than thesevere pulmonary hypertension group, and their differences had statistical significance (P<0.05). Pulmonary artery pressure normal group had higher right ventricular Tei index than the control group, and the difference had statistical significance (P<0.05). Conclusion Right ventricular Tei index is more sensitive to reflect severty of illness and right ventricular function for COPD patients than traditional ultrasonic indexes, and it contains good clinical application value.