摘要
目的：运用超声心动图研究先天性心脏病（CHD）合并肺动脉高压（PH）患者的心脏结构及血流动力学特点，对比右心导管结果，探讨超声心动图对PH的评估方法。方法：选择CHD-室间隔缺损及动脉导管未闭合并不同程度PH患者60例，经右心导管检查，根据全肺阻力将PH分级为Ⅰ、Ⅱ、Ⅲ级，每级20例，经胸超声心动图测量双心室舒张末期前后径及左右径（RVT、LVT）、双心室左右径比值（RVT／LVT）、右室舒张末期前壁厚度（RVAWT），多普勒测量室水平、动脉水平左向右分流速度（FLV）等参数，分析不同程度PH的心脏结构及血流动力学特点，总结超声心动图对PH的评估标准。结果：Ⅰ级PH表现为动力型肺动脉高压，左室明显增大，右室不大，RVT／LVT=1／2～2／3，RVAWT正常，分流为左向右大量分流，FLV2．5～3．5m／s；Ⅱ级PH时逐渐表现出阻力型肺高压特点，左室回缩至轻度增大至正常大小，右室开始增大，RVT／LVT=2／3～1，RVAWT轻度增厚，左向右分流变为低速，FLV1．5～2．5m／s；Ⅲ级PH肺阻力严重增高，肺血流量显著减少，左室内径缩小，右室内径明显增大，RVT／LVT≥1，RVAWT明显增厚，FLV〈2．0m／s，出现明显右向左分流。全部指标中，RVAWT（r=0．89，P=0．000）、RVT／LVT（r=0．84，P=0．000）、FLV（r=-0．73，P=0．000）与全肺阻力相关性最好，且各组间差异有统计学意义（P=0．000）。结论：超声心动图能够准确反映肺动脉高压的阶段和程度，为临床分级提供可靠依据。
Objective To make an approach to evaluation of pulmonary hypertension （PH） by investigating the characteristics of cardiac structure and hemodynamics in left to right shunt congenital heart disease（CHD） complicated with PH by echocardiography. Methods A total of 60 patients with CHD, including ventricular septal defect and patent ductus arteriosus complicated with different level of PH, were included in the investigation. Based on the values of total pulmonary resistance （TPR） measured by right heart catheterization,PH was graded into three classes, each contained 20 cases. The left ventricular（LV） and right ventricular（RV） anterior-posterior internal diameters at end diastole, the LV and RV left-right internal diameters at end diastole（LVT,RVT） and their ratio （RVT/LVT）,the RV anterior wall thickness （RVAWT）, the shunt flow velocity （FLV） were measured by Doppler echocardiography. The echocardiographic grading criteria for PH could be concluded through analyzing the characteristics of cardiac structures and hemodynamics in different classes of PH. Results Class Ⅰ made a feature of the dynamic PH ,of which LV was markedly enlarged, while the RV kept normal, the RVT/LVT varied from 1/2 to 2/3, the RVAWT was not thick and the shunt was regarded as the left-to-right high speed flow with the FLV value of 2.5 m/s to 3.5 m/s. Class Ⅱ was characterized with the resistant PH, the enlarged LV withdrew to mild dilation even to normal diameter, whereas, the RV became enlarged, the RVT/LVT was within 2/3 to 1, the RVAWT was mildly incrassated, the left-to-right FLV decreased to lower level with the FLV value of 1.5 m/s to 2.5 m/s. In the case of class Ⅲ ,the TPR increased extremely,the LV deflated in contrast to the enlargement of RV noticeably,and RVT/LVT≥1 ,the RVAWT continued to be incrassated with FLV〈2.0m/s,concurrently, distinct right-to-left shunt appeared. Of all the parameters, RVAWT （ r = 0.89, P = 0.000） ,RVT/LVT（ r = 0.84, P = 0.000） and FLV（ r = -0.73, P = 0.000） had the best correlation with the TPR, and there were significant differences among three classes （ P = 0. 000 ）. Conclusions Echocardiography could accurately reflect the different phases and degree of PH in CHD, which provided dependable evidence for the clinical gradation.
出处
《中华超声影像学杂志》
CSCD
2007年第6期481-486,共6页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
室间隔缺损
动脉导管未闭
高血压
肺性
Echocardiography
Heart septal defects, ventricular
Ductus arteriosus, patent
Hypertension, pulmonary
