超声心动图评估心脏移植患者术前肺动脉压力对术后早期右心功能的影响

The effect of preoperative pulmonary artery pressure on early postoperative right ventricular function in patients with heart transplantation

目的探讨左心衰竭患者行心脏移植术前肺动脉压力高低程度对术后早期右心功能的影响。方法回顾性分析2010年8月至2018年2月于山东第一医科大学第一附属医院心脏移植中心,因终末期心力衰竭接受原位心脏移植手术的79例患者的临床资料。超声心动图通过三尖瓣反流压差与右心房压力之和得出肺动脉收缩压(PASP),依据PASP是否≥45 mmHg(1 mmHg=0.133 kPa),分为肺动脉高压组(n=45)和对照组(n=34)。分析比较两组患者术前一般资料、术中体外循环时间和术后早期右心功能情况。结果肺动脉高压组术前右室流出道前向血流加速时间(RVact)为(96.83±8.53)ms,对照组为(106.00±4.90)ms,差异有统计学意义(t=-6.05,P<0.01)。肺动脉高压组术中体外循环时间[(266.69±71.80)min]高于对照组[(221.24±70.19)min],差异有统计学意义(t=2.81,P<0.01)。术后第3天行超声心动图测量两组患者右室游离壁纵向应变(RVLS)[(-12.19±2.03)%,(-19.22±2.06)%]和右室面积变化分数(RVFAC)[(26.88±6.15)%,(36.50±2.17)%]比较,均差异有统计学意义(t=15.11,-9.72;均P<0.01)。术后第15天行超声心动图测量两组患者RVLS[(-12.02±1.99)%,(-19.40±1.82)%]、三尖瓣环收缩期位移(TAPSE)[(17.46±2.06)mm,(18.68±1.74)mm]和RVFAC[(29.50±6.28)%,(37.60±2.72)%]比较,均差异有统计学意义(t=17.14,-2.85,-7.74;均P<0.01)。结论术前PASP≥45 mmHg患者更容易在心脏移植术后早期发生严重右心功能不全。

Objective To investigate the effect of the preoperative pulmonary artery pressure on early postoperative right ventricular function in patients undergoing heart transplantation with left heart failure and receiving the heart transplantation.MethodsA retrospective analysis was made,which was based on 79 patients who underwent the orthotopic cardiac transplantation for end-stage heart failure at the Heart Transplantation Center,the First Affiliated Hospital of Shandong First Medical University from August 2010 to February 2018.The systolic pulmonary artery pressure(PASP)was defined as the sum tricuspid regurgitation pressure difference and right atrial pressure measured by echocardiography.The patients were divided into the pulmonary hypertension group(preoperative PASP≥45 mmHg,1 mmHg=0.133 kPa),n=45 and the control group(preoperative PASP<45 mmHg,n=34)respectively.The preoperative general data,the intraoperative cardiopulmonary bypass time,and the early postoperative right heart function were analyzed and compared between the two groups.ResultsThe preoperative right ventricular outflow tract forward blood flow acceleration time(RVact)was(96.83±8.53)ms in the pulmonary hypertension group,(106.00±4.90)ms in the control group.The difference was statistically significant(t=-6.05,P<0.01).The intraoperative cardiopulmonary bypass time of pulmonary hypertension group[(266.69±71.80)min]was higher than that of the control group[(221.24±70.19)min],the difference was statistically significant(t=2.81,P<0.01).The right ventricular longitudinal strain(RVLS)[(-12.19±2.03)%,(-19.22±2.06)%]and the right ventricular fractional area change(RVFAC)[(26.88±6.15)%,(36.50±2.17)%]were analyzed by echocardiography 3 days after operation between the two groups,and the differences were statistically significant(t=15.11,-9.72,all P<0.01).In addition,the differences of RVLS[(-12.02±1.99)%,(-19.40±1.82)%],tricuspid annular plane systolic excursion(TAPSE)[(17.46±2.06)mm,(18.68±1.74)mm]and RVFAC[(29.50±6.28)%,(37.60±2.72)%]between the two groups in echocardiography 15 days after operation were also statistically significant(t=17.14,-2.85,-7.74,all P<0.01).ConclusionPatients with preoperative PASP≥45 mmHg are more likely to develop the severe right ventricular insufficiency in the early postoperative period after heart transplantation.