右心声学造影在肝硬化患者肺内血管分流评价中的应用

Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis

目的探讨右心声学造影在肝硬化患者肺内血管分流的评价中的应用价值。方法2019年7月至2019年9月,对首都医科大学附属北京地坛医院收治的186例肝硬化住院患者使用维生素B6与碳酸氢钠注射液的混合液进行右心声学造影。记录检查过程中的不良反应。通过采集动态图像,对于存在肺内分流的患者,选择左心房微泡最为密集的图像进行分析,对微泡量进行半定量分析评估是否存在肺内血管分流。收集分流阳性的患者的右心声学造影检查资料以及临床资料进行分析,评估其高危因素。结果186例患者中,男性125例(67.2%),女性61例(32.8%)。年龄为(53.4±9.9)岁,范围为26~70岁。全部患者耐受性良好,仅2例患者感注射部位轻微疼痛,但不影响实验完成。无不良事件发生。检出存在大量分流4例(2.15%),中量分流6例(3.22%),少量分流38例(20.43%),无分流的患者138例(74.19%)。大量分流的患者与少量分流的患者相比,静脉注射混合液后心腔左房微气泡出现的时间更快。进一步分析显示,肝硬化患者肺内分流量大小与肝硬化程度之间Spearman相关系数为0.463,呈正相关,肝硬化Child-Pugh分级越高的患者,肺内分流量也越大。结论维生素B6与碳酸氢钠混合液可安全有效地应用于肝硬化人群进行右心声学造影。肝硬化人群肺内分流大小与肝硬化严重程度密切相关。

Objective To investigate the application value of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis.Methods One hundred and eigthy-six inpatients with liver cirrhosis admitted to our hospital from July 2019 to September 2019 underwent the right heart contrast echocardiography,and vitamin B6 and sodium bicarbonate were used as contrast agents.The adverse reactions during the inspection were recorded.The dynamic images were collected.The image with the most densest area of microbubble in left atrium of patients with intrapulmonary shunt was analyzed,and the amount of microbubbles was semi-quantitatively analyzed to evaluate the existence of intrapulmonary vascular shunt.The right-heart contrast echocardiography and clinical data of patients with intrapulmonary shunt were analyzed to evaluate the high-risk factors.Results Among the 186 patients,125 were males(67.2%)and 61 were females(32.8%),patients mean age ranged from 26 to 70 years old(53.4±9.9 years old).All patients had a good tolerance,and only 2 patients felt slight pain at the injection site,with no effect on the experiment.No adverse events occurred.4 cases(2.15%)with a large volume of shunt,6 cases with a medium volume of shunt(3.22%),38 cases(20.43%)with a small volume of shunt,and 138 cases(74.19%)with no intrapulmonary shunt.Compared to the patients with a small volume of shunt,the appearance of microbubbles in the left atrium was earlier in patients with a large volume of shunt after contrast agents were injected.Further analysis showed that the Spearman correlation coefficient between the volume of the pulmonary shunt and the degree of cirrhosis in patients with liver cirrhosis was 0.463,which was a positive correlation.The volume of the intrapulmonary shunt became larger as the Child-Pugh grade of liver cirrhosis got higher.Conclusion The vitamin B6 and sodium bicarbonate mixed liquors can be a safe and effective contrast agent used in patients with liver cirrhosis for right-heart contrast echocardiography.The volume of intrapulmonary shunt is closely related to the severity of hepatic cirrhosis in patients with liver cirrhosis.