多普勒超声心动图评估肺源性心脏病患者右心功能的意义

The significance of Doppler echocardiography in evaluating right ventricular function in patients with pulmonary heart disease

目的 探讨多普勒超声心动图评估肺源性心脏病患者右心功能的意义.方法 抽取60例肺源性心脏病患者,按照不同病程分为急性期组与缓解期组,各30例.抽取同期健康体检者30例作为对照组,均给予多普勒超声心动图检查,比较三组右心腔径线及其他指标[右心房(RA)左右径、RA上下径、RA面积、右心室(RV)基底段横径、RV中间段横径、RV面积、RV流出道近端内径、RV流出道远端内径、肺动脉收缩压、肺动脉瓣口流速、肺动脉主干内径、下腔静脉内径、下腔静脉塌陷指数];三组右心室收缩功能[右心室面积变化分数(FAC)、脉冲心肌做功指数(MPI)、组织MPI、三尖瓣环位移(TAPSE)、游离壁三尖瓣环收缩期纵向收缩最大速度(S')];三组右心室局部容积[RV流入道、RV流出道、心尖小梁部的舒张末期容积(rEDV)、收缩末期容积(rESV)];三组右心室舒张功能[三尖瓣口早期充盈峰值速度(TVE)/舒张晚期峰值速度(TVA)、TVE/三尖瓣环舒张早期峰值速度(TVe')、E峰减速时间].结果 三组RA左右径、RA上下径、RA面积、RV基底段横径、RV中间段横径、RV面积、RV流出道近端内径、RV流出道远端内径、肺动脉收缩压、肺动脉瓣口流速、肺动脉主干内径、下腔静脉内径、下腔静脉塌陷指数比较差异均有统计学意义(P<0.05).三组S'比较差异无统计学意义(P>0.05);三组FAC、脉冲MPI、组织MPI、TAPSE比较差异有统计学意义(P<0.05).急性期组TVE/TVA、TVE/TVe'、E峰减速时间分别为(0.72±0.15)、(3.71±0.25)、(145.25±12.62)ms,缓解期组分别为(0.82±0.18)、(4.25±1.05)、(154.23±19.36)ms,对照组分别为(1.13±0.25)、(5.36±2.12)、(195.25±26.36)ms.三组TVE/TVA、TVE/TVe'、E峰减速时间比较差异有统计学意义(P<0.05).三组RV流入道、RV流出道、心尖小梁部的rEDV、rESV比较差异有统计学意义(P<0.05).结论 多普勒超声心动图评估肺源性心脏病患者右心功能的意义显著,可为临床诊断、评估病情严重程度等提供参考,值得推广.

Objective To discuss the significance of Doppler echocardiography in evaluating right ventricular function in patients with pulmonary heart disease.Methods A total of 60 patients with pulmonary heart disease were divided into acute group and remission group by different courses of disease,with 30 cases in each group.30 healthy medical examinees were selected as the control group during the same period.Three groups were examined by Doppler echocardiography.The right heart cavity diameter and other indicators[right atrium(RA)left and right diameter,RA upper and lower diameter,RA area,cross diameter of right ventricular(RV)basal segment,cross diameter of RV middle segment,RV area,proximal diameter of RVoutflow tract,distal diameter of RVoutflow tract,pulmonary artery systolic pressure,pulmonary valve orifice velocity,pulmonary artery trunk diameter,inferior vena cava diameter,inferior vena cava collapse index],right ventricular systolic function[fractional area change(FAC),myocardial performance index(MPI),tissue MPI,tricuspid annular plane systolic excursion(TAPSE),tricuspid annular systolic peak velocity(S')],local volume of right ventricle[regional end diastolic volume(rEDV)and regional end systolic volume(rESV)of RV inflow,RV outflow,apical trabecular],right ventricular diastolic function[tricuspid early diastolic peak of E wave(TVE)/tricuspid early diastolic peak of A wave(TVA),TVE/peak early diastolic tricuspid annular velocity(TVe'),E-peak deceleration time]were compared among three groups.Results There was statistically significant difference in left and right diameter of RA,upper and lower diameter of RA,RA area,cross diameter of RV basal segment,cross diameter of RV middle segment,RV area,proximal diameter of RVoutflow tract,distal diameter of RVoutflow tract,pulmonary artery systolic pressure,pulmonary valve orifice velocity,pulmonary artery trunk diameter,inferior vena cava diameter,inferior vena cava collapse index among three groups(P<0.05).There was no statistically significant difference in S'among three groups(P>0.05).There was statistically significant difference in FAC,pulse MPI,tissue MPI,TAPSE among three groups(P<0.05).TVE/TVA,TVE/TVe'and E-peak deceleration time of acute group were(0.72±0.15),(3.71±0.25)and(145.25±12.62)ms,which were(0.82±0.18),(4.25±1.05)and(154.23±19.36)ms of remission group,and(1.13±0.25),(5.36±2.12)and(195.25±26.36)ms of control group.There was statistically significant difference in TVE/TVA,TVE/TVe'and E-peak deceleration time among three groups(P<0.05).There was statistically significant difference in rEDV and rESV of RV inflow,RV outflow,apical trabecular among three groups(P<0.05).Conclusion Doppler echocardiography is of great significance in assessing the right venticular function of patients with pulmonary heart disease.It can provide a reference for clinical diagnosis and assessment of the severity of the disease,and is worth promoting.