發(fā)布時間：2018-04-05 14:21

  本文選題：斑點(diǎn)追蹤技術(shù)　切入點(diǎn)：肺動脈高壓　出處：《中國超聲醫(yī)學(xué)雜志》2017年10期

【摘要】：目的應(yīng)用超聲二維斑點(diǎn)追蹤技術(shù)測量肺動脈高壓(PH)患者右室游離壁縱向應(yīng)變(RVLS_(FW)),探討該參數(shù)在評估PH患者不良預(yù)后方面的臨床應(yīng)用價值。方法臨床經(jīng)右心導(dǎo)管確診、資料完整PH患者50例。臨床資料參數(shù)包括:WHO功能分級(WHO FC)、6min步行距離(6MWD)及N端腦利鈉肽前體(NT-proBNP)。超聲心動圖檢測參數(shù)包括:右室游離壁縱向應(yīng)變(RVLS_(FW))、三尖瓣環(huán)收縮期位移(TAPSE)、右室面積變化分?jǐn)?shù)(FAC)、三尖瓣環(huán)收縮期峰值速度(s′)及右心做功指數(shù)(RIMP);三尖瓣反流壓差法估測肺動脈收縮壓(sPAP)。右心導(dǎo)管參數(shù)包括:肺動脈平均壓(mPAP)、肺毛細(xì)血管阻力(PVR)、肺毛細(xì)血管楔壓(PCWP)及心指數(shù)(CI)。結(jié)果 (1)RVLS_(FW)與CI呈負(fù)相關(guān)關(guān)系(r=-0.692,P0.001),與PVR呈正相關(guān)關(guān)系(r=0.684,P0.001)。(2)以死亡、肺動脈血栓內(nèi)膜剝脫術(shù)、急性心力衰竭再入院作為不良預(yù)后事件,隨訪時間(15.2±10.5)個月,有26例患者出現(xiàn)不良事件。多因素COX回歸分析NT-proBNP(HR=1.000,P=0.028)及RVLS_(FW)(HR=2.084,P=0.046)與不良預(yù)后事件密切相關(guān)。(3)以RVLS_(FW)值中位數(shù)-16%為界值將患者分為2組:組Ⅰ(RVLS_(FW)值-16%),組Ⅱ(RVLS_(FW)值-16%)。組Ⅱ患者較組Ⅰ患者sPAP升高,RVLS_(FW)減低(P0.01)。2組患者mPAP、PVR、PCWP及CI之間差異有統(tǒng)計(jì)學(xué)意義(P0.01);組Ⅱ患者mPAP、PCWP及PVR明顯升高,CI較組Ⅰ患者明顯減低。組Ⅱ患者發(fā)生不良事件及死亡風(fēng)險(xiǎn)升高,遠(yuǎn)期預(yù)后不佳(χ~2=12.299,P0.001)。結(jié)論右室游離壁縱向應(yīng)變能夠反映PH患者右心功能減低程度,有助于預(yù)測患者不良預(yù)后,為臨床綜合管理PH患者提供有價值的參考指標(biāo)。
[Abstract]:Objective to measure the longitudinal strain of right ventricular free wall in patients with pulmonary hypertension (PHH) by using two dimensional ultrasonic speckle tracing technique and to explore the clinical value of this parameter in evaluating the poor prognosis of patients with PH.Methods 50 patients with PH were diagnosed by right cardiac catheterization.The clinical data included 6 MWDs (6 minutes walking distance) and NT-proBNPP, a precursor of N-terminal brain natriuretic peptide (NT-proBNPP).Method to estimate pulmonary arterial systolic pressure (PAP).The parameters of right cardiac catheterization included mean pulmonary artery pressure (MPAP), pulmonary capillary resistance (PVR), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI).The adverse events and the risk of death were increased in group 鈪，

本文編號：1715158