超声心动图测量肺动脉压力校正方法的研究

Clinical Evaluation of Pulmonary Arterial Pressure by Corrected Measurement Method Derived From Echocardiography

目的:采用超声心动图测量肺动脉压力,研究其校正方法,并与右心漂浮导管法作比较,以探查经校正过的测量方法是否较为精确。方法:选取我院经右心漂浮导管检测肺动脉压力的患者30例,同一天行超声心动图检查,通过测算下腔静脉压评估右心房压以及测算肺动脉瓣过瓣压两个因素来校正超声心动图测量的肺动脉收缩压、肺动脉平均压与肺动脉舒张压,校正前及校正后分别与右心漂浮导管法的测量值相比较。结果:未校正超声心动图法与右心漂浮导管法比较,肺动脉收缩压、肺动脉舒张压、肺动脉平均压的差异均有统计学意义(P=0.028、0.013、0.044);校正后超声心动图法与右心漂浮导管法比较,肺动脉收缩压、肺动脉舒张压、肺动脉平均压差异均无统计学意义(P=0.181、0.351、0.505)。校正后超声心动图法测肺动脉收缩压、肺动脉舒张压、肺动脉平均压(r=0.95、0.91、0.96)比未校正时(r=0.88、0.89、0.94)更接近右心漂浮导管法测量值,相关性更高。结论:校正后超声心动图法测量肺动脉压力与右心漂浮导管法的测量值更接近,有更高的临床价值。

Objectives:We observed the clinical value of measuring pulmonary arterial pressure by corrected measurement method derived from echocardiography,the value obtained by the right heart catheterization served as gold standard.Methods:Thirty patients with pulmonary arterial pressure detected by right heart catheterization in our hospital were selected.Echocardiography and right heart catheterization were performed on the same day.We estimated inferior cava vena pressure to define right atrial pressure and measured pulmonary valve pressure gradient.We corrected pulmonary arterial systolic pressure(PASP),pulmonary arterial mean pressure(PAMP)and pulmonary arterial diastolic blood pressure(PADP)measured by echocardiography with these two factors,and compared the echocardiographic results before and after correction with measurements derived from right heart catheterization.Results:PASP,PADP and PAMP estimated by echocardiography before correction were significantly different as the results derived from right heart catheterization(P=0.028,0.013,0.044),these differences disappeared after echocardiographic correction with inferior cava vena pressure and pulmonary valve pressure gradient(P=0.181,0.351,0.505).Measurements of PASP,PADP and PAMP by corrected method with inferior cava vena pressure and pulmonary valve pressure gradient(r=0.95,0.91,0.96)were closer to the measurement results derived from right heart catheterization than before correction(r=0.88,0.89,0.94).Conclusions:The corrected echocardiographic measurement method of pulmonary arterial pressure by inferior cava vena pressure and pulmonary valve pressure gradient were closer to the measurement values derived from right heart catheterization and thereby has a higher clinical value for the correct evaluation of PASP,PAMP and PADP.