右心室形态学检测对儿童先天性心脏病相关性肺动脉高压的临床价值

Clinical value of right ventricular morphology in children with congenital heart disease associated pulmonary hypertension

目的探讨超声心动图右心室形态学检测对儿童先天性心脏病相关性肺动脉高压的临床价值。方法选取2014年10月至2017年10月唐山市妇幼保健院就诊的先天性心脏病无相关性肺动脉高压(静息状态下肺动脉收缩压≤30 mmHg,1 mmHg=0.133 kPa)患儿37例为A组,先天性心脏病合并相关性肺动脉高压(静息状态下肺动脉收缩压>30 mmHg)患儿37例为B组,健康儿童37名为对照组。均行超声心动图检查,比较3组右心室形态学及右心室收缩功能的检测结果。结果(1)右心室形态学指标:B组右心房上下径[(56.8±4.0)mm]、左右径[(49.2±3.3)mm]、基底段内径[(43.7±2.5)mm]、中段内径[(41.7±3.9)mm]、长轴距离[(73.4±6.2)mm]、胸骨旁观右心室流出道近端内径[(37.8±2.4)mm]、短轴观右心室流出道远端内径[(33.6±2.1)mm]、主肺动脉内径[(30.5±2.5)mm]、右心室舒张末期面积[(31.6±1.8)cm2]及收缩末期面积[(19.0±2.7)cm2]均高于A组[(46.2±3.1)mm、(40.4±2.8)mm、(34.6±2.2)mm、(32.5±2.6)mm、(65.1±4.7)mm、(30.2±2.0)mm、(29.4±1.8)mm、(23.0±1.6)mm、(22.5±1.1)cm2、(11.6±1.2)cm2]和对照组[(45.3±2.6)mm、(39.5±1.7)mm、(34.0±1.9)mm、(31.8±2.0)mm、(63.2±3.8)mm、(29.6±1.7)mm、(28.9±1.5)mm、(22.4±1.4)mm、(22.1±1.0)cm2、(11.3±0.9)cm2],差异有统计学意义(F值分别为140.26、147.47、223.08、130.46、43.56、183.33、74.71、209.94、587.99、221.34,P均<0.01)。(2)右心室收缩功能指标:B组的右心室面积变化率[(40.1±1.6)%]、三尖瓣环收缩期位移[(2.2±0.2)cm]、三尖瓣收缩期峰值流速[(13.8±0.9)cm/s]均低于A组{[(46.3±1.7)%]、[(2.5±0.3)cm]、[(16.7±1.2)cm/s]}和对照组{[(46.8±1.5)%]、[(2.6±0.3)cm]、[(17.2±1.4)cm/s]},差异有统计学意义(F值分别为200.81、21.86、88.85,P均<0.01)。结论儿童先天性心脏病相关性肺动脉高压患者存在右心室形态学改变和右心室收缩功能降低,右心室形态学检测具有重要的临床价值。

Objective To investigate clinical value of right ventricular morphology in children with congenital heart disease associated pulmonary hypertension.Methods From October 2014 to October 2017,37 children with congenital heart disease without associated pulmonary hypertension(resting pulmonary systolic pressure≤30 mmHg,1 mmHg=0.133 kPa)were selected as group A.Thirty-seven children with congenital heart disease and associated pulmonary hypertension(resting pulmonary systolic pressure>30 m).were in group B,and 37 healthy children were in control group.Echocardiography was performed to compare the results of right ventricular morphology and systolic function in three groups.Results(1)Right ventricular morphology indexes:right atrium upper and lower diameter((56.8±4.0)mm),right atrium left and right diameter((49.2±3.3)mm),right ventricle basal segment inner diameter((43.7±2.5)mm),right ventricle medial diameter((41.7±3.9)mm),right ventricle long axis distance((73.4±6.2)mm),sternum sidelines right ventricular outflow tract proximal end diameter((37.8±2.4)mm),short axis view right ventricular outflow tract distal internal diameter((33.6±2.1)mm),main pulmonary artery internal diameter((30.5±2.5)mm),right ventricle end diastolic area((31.6±1.8)cm2),right ventricle end systolic area((19.0±2.7)cm2)in group B were higher than those in group A((46.2±3.1)mm,(40.4±2.8)mm,(34.6±2.2)mm,(32.5±2.6)mm,(65.1±4.7)mm,(30.2±2.0)mm,(29.4±1.8)mm,(23.0±1.6)mm,(22.5±1.1)cm2,(11.6±1.2)cm2)and control group((45.3±2.6)mm,(39.5±1.7)mm,(34.0±1.9)mm,(31.8±2.0)mm,(63.2±3.8)mm,(29.6±1.7)mm,(28.9±1.5)mm,(22.4±1.4)mm,(22.1±1.0)cm2,(11.3±0.9)cm2),(F=140.26,147.47,223.08,130.46,43.56,183.33,74.71,209.94,587.99,221.34,all P<0.01).(2)Right ventricle contractile function indexes:right ventricular area change rate((40.1±1.6)%),three tricuspid ring systolic displacement((2.2±0.2)cm),tricuspid valve peak systolic flow velocity((13.8±0.9)cm/s)in group B were lower than those in group A((46.3±1.7)%,(2.5±0.3)cm,(16.7±1.2)cm/s)and control group((46.8±1.5)%,(2.6±0.3)cm,(17.2±1.4)cm/s),the difference was statistically significant(F=200.81,21.86,88.85,all P<0.01).Conclusion Children with congenital heart disease associated pulmonary hypertension have right ventricle morphological changes and right ventricular systolic function decreasing.Right ventricular morphological examination has important clinical value.