右心声学造影联合肺部超声对肝肺综合征的诊断及随访价值

Diagnostic and follow-up value of right heart contrast echocardiography combined with lung ultrasound in hepatopulmonary syndrome

目的探讨右心声学造影联合肺部超声对肝肺综合征的诊断及随访价值。方法收集2021年1月至2022年7月经我院诊断为肝硬化且符合入组标准的92例患者为研究对象,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。比较肝肺综合征患者组与非肝肺综合征患者组的临床基线资料,分析肝肺综合征发生的危险因素。同时对肝肺综合征组病例患者的肺部CT和肺部超声特征进行比较,分析两者一致性。结果92例患者中右心声学造影阳性者共15例,均在3-4个心动周期后左心见微泡显影。同非肝肺综合征组比较,肝肺综合征组在呼吸困难、蜘蛛痣、Child-Pugh分级AC级、血红蛋白、血小板等指标有统计学差异(P<0.05)。肝肺综合征患者肺部超声主要表现为胸膜增厚、双下肺B线增多且融合,在胸膜增厚诊断上肺部超声敏感性高于肺部CT,其它征象同肺部CT有较高一致性。结论右心声学造影联合肺部超声检查对肝肺综合征具有重要诊断及随访价值。

Objective To investigate the value of right heart contrast echocardiography combined with lung ultrasound in the diagnosis and follow-up of hepatopulmonary syndrome.Methods Ninety-two patients diagnosed with liver cirrhosis and meeting the enrollment criteria from January 2021 to July 2022 were collected for the study,and right heart contrast echocardiography was performed using a mixture of vitamin B 6 and sodium bicarbonate injection.The clinical baseline data of the group of patients with hepatopulmonary syndrome were compared with those of the group of patients without hepatopulmonary syndrome,and the risk factors for the development of hepatopulmonary syndrome were analyzed.Pulmonary CT and pulmonary ultrasound features of patients in the hepatopulmonary syndrome group were also compared to analyze their concordance.Results 15 of 92 patients with positive contrast echocardiography of right heart were found microbubbles in left heart after 3-4 cardiac cycle.Compared with the non-hepatopulmonary syndrome group,the hepatopulmonary syndrome group showed statistical differences in dyspnea,sideroblastic nevus,Child-Pugh classification,hemoglobin,and platelets(P<0.05).In the group of patients with hepatopulmonary syndrome,lung ultrasound mainly showed pleural thickening and increased and fused B-lines in both lower lungs.Lung ultrasound was more sensitive than lung CT in the diagnosis of pleural thickening,and other signs were in high agreement with lung CT.Conclusion Right heart contrast echocardiography combined with lung ultrasound is of great diagnostic and follow-up value in hepatopulmonary syndrome.