| 摘要: |
| 目的 应用多种多普勒技术单独或协同评估房间隔缺损（ASD）合并肺动脉高压患者肺动脉压力的应用价值，以及与右心导管测压的相关性的研究。方法 纳入我院心胸外科拟行封堵术或修补术的75 例ASD患者，所有患者均在24小时内行完成胸超声心动图检查和右心导管测压。根据右心导管所测肺动脉平均压（mPAP）分为肺动脉高压（PAH）组43例和无肺动脉高压（non-PAH）组32例。多普勒指标包括：三尖瓣反流峰值速度（VTR）；组织多普勒测得三尖瓣环游离壁收缩期位移（TAPSE）、等容收缩时间（ICT）、等容舒张时间（IRT）、射血时间（ET），并计算出Tei指数；以上各超声心动图参数与右心导管测得的肺动脉收缩压（sPAP）、肺动脉平均压（mPAP）以及肺动脉舒张压（dPAP）行相关性分析。结果 ①PAH组TAPSE、ET较non-PAH组明显降低（P<0.05），而VTR、PASPTR、ICT+IRT、Tei指数较non-PAH组明显升高（P<0.05）；②VTR与sPAP、mPAP、dPAP呈正相关（P＜0.001），以VTR=3.3m/s为截断值诊断PAH的敏感性为83%，特异性为72%；③Tei指数与sPAP、mPAP、dPAP呈正相关（P＜0.001），以Tei=0.51为截断值诊断PAH的敏感性为81%，特异性为71%；④联合应用VTR和Tei指数诊断PAH的敏感性提高至86%、特异性提高至93%。结论 多种多普勒参数在帮助临床诊断ASD-PAH时均显示出了较高的实用价值，其中又以Tei指数和VTR效果最显著，而将两者联合应用则能进一步明显提高PAH诊断的敏感度和特异性。 |
| 关键词: 肺动脉高压 多普勒技术 房间隔缺损 右心导管 超声心动描记术 |
| DOI： |
| 投稿时间：2017-10-21修订日期：2017-11-20 |
| 基金项目:浙江省卫生和计划生育委员会一般项目（2017KYA020，2015KYA022） |
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| Evaluation of atrial septal defect disease associated with pulmonary arterial hypertension patients using Doppler techniques |
| dupei,hou chun jie |
| (Zhejiang Provincial People's Hospital(People's Hospital of Hang Zhou Medical College)) |
| Abstract: |
| Objective To explore the diagnostic value and the relationship between the cardiac catheterization findings and Doppler techniques alone or together in atrial septal defect disease associated with pulmonary arterial hypertension patients (ASD-PAH). Methods A total of 75 cases of ASD approved by operation or intervention were retrospectively analyzed, Both Doppler parameters and right cardiac catheterization were performed in all patients in 24 hours. All selected patients were divided into two groups according to mean pulmonary arterial pressure (mPAP) on diagnostic right cardiac catheterization: 43 PAH patients and 32 non-PAH patients. Doppler indexes included the peak of tricuspid regurgitation velocities (VTR ) 、tricuspid annular plane systolic excursion (TAPSE)、isovolumetric contraction time（ICT）、isovolumetric relaxation time（IRT）、ejection time（ET）were measured by Doppler tissue imaging and calculated. Correlation analyses were performed to assess the relation between each Doppler index and the cardiac catheterization findings (sPAP, mPAP and dPAP). Results ①Compared to non-PAH groups, TAPSE、ET were significantly lower (P<0.05), but VTR、PASPTR、ICT+IRT、Tei were significantly higher those in the PAH groups (P<0.05); ②A positive correlation was found between VTR and sPAP, mPAP and dPAP ( P＜0.001), at the cut-off 3.3m/s for diagnosing PAH the sensitivity and specificity were 83% and 72% ; ③Tei was also found to be positively correlated with sPAP, mPAP and dPAP(P＜0.001), at the cut-off 0.51 for diagnosing PAH the sensitivity and specificity were 81%,71%; ④The concurrent use of VTR and Tei index to diagnose PAH the sensitivity and specificity were up to 86% and 93% . Conclusion A variety of Doppler parameters , especially Tei index and VTR can offer a new quantitative diagnostic method, when used in conjunction can obviously increase the sensitivity and specificity of PAH diagnosis. |
| Key words: Pulmonary arterial hypertension Doppler imaging Atrial septal defect The right cardiac catheterization Echocardiography |
