彩色多普勒超聲檢測(cè)肺血管阻力的價(jià)值
發(fā)布時(shí)間：2018-07-31 17:01
【摘要】：目的：右心導(dǎo)管術(shù)目前是測(cè)量肺血管阻力(Pulmonary vascular resistance, PVR)的金標(biāo)準(zhǔn),但因其為創(chuàng)傷性檢查操作復(fù)雜,費(fèi)用較高,本研究用多普勒超聲心動(dòng)圖無創(chuàng)測(cè)量PVR,并與右心導(dǎo)管術(shù)(Right-heart catheterization, RHC)結(jié)果比較。評(píng)價(jià)超聲測(cè)量的準(zhǔn)確性。 方法：選取2013.01～2013.12在昆明醫(yī)科大學(xué)第一附屬醫(yī)院心臟彩超室行超聲心動(dòng)圖(Ultrasonic cardiogram, UCG)檢查有肺動(dòng)脈收縮壓(Pulmonary artery systolic pressure, PASP)升高者(PASP35mmHg)29例。患者行多普勒超聲心動(dòng)圖檢查,用三尖瓣反流速度與右室流出道速度-面積乘積比(TRV/VArvot);三尖瓣反流速度與右室流出道時(shí)間流速積分比(TRV/VTIrvot);肺動(dòng)脈瓣最大反流速度與肺動(dòng)脈血流速度時(shí)間積分(PIV/VTIpa)及三尖瓣反流壓差與左室流出道時(shí)間流速積分比(TRV/VTlvot)測(cè)量肺血管阻力。對(duì)該部分同時(shí)行右心導(dǎo)管術(shù)測(cè)量肺血管阻力,記錄肺動(dòng)脈收縮壓、肺動(dòng)脈舒張壓(Pulmonary artery diastolic pressure PADP)、肺動(dòng)脈平均壓(pulmonary artery mean pressure, PAMP)、肺毛細(xì)血管楔壓(Pulmonary capillary wedge pressure PCWP)。根據(jù)Fick法計(jì)算肺血流量QP,再根據(jù)Poiseuille公式PVR=(PAMP-PC WP)/QP計(jì)算出PVR。超聲心動(dòng)圖組四種測(cè)量方法分別與右心導(dǎo)管法肺血管阻力測(cè)量結(jié)果組進(jìn)行線性回歸分析及Bland-Altman分析。 結(jié)果：四種多普勒超聲心動(dòng)圖測(cè)量的肺血管阻力值與右心導(dǎo)管測(cè)量的肺血管阻力值均呈正相關(guān)(r=0.71、0.76、0.69、0.74,P0.05),其中TRV/VTIrvot法相關(guān)性最高。Bland-Altman方法分析的結(jié)果為,TRV/VArvot測(cè)量PVR與右心導(dǎo)管測(cè)量PVR在95%的可信區(qū)間(-1.13WU～1.13WU)內(nèi)：TRV/VTIrvot測(cè)量PVR與右心導(dǎo)管測(cè)量PVR在95%的可信區(qū)間(-1.01WU～1.01WU)內(nèi)；PIV/VTIpa測(cè)量PVR與右心導(dǎo)管測(cè)量PVR在95%的可信區(qū)間(-1.10WU～1.10WU)內(nèi)；TRV/VTIlvot測(cè)量PVR與右心導(dǎo)管測(cè)量PVR在95%的可信區(qū)間(-1.21WU～1.21WU)內(nèi)。 結(jié)論：1.多普勒超聲心動(dòng)圖估測(cè)肺血管阻力和右心導(dǎo)管術(shù)測(cè)量肺血管阻力,兩者的結(jié)果呈高度相關(guān)性,相關(guān)系數(shù)為0.69～0.76,多普勒超聲心動(dòng)圖可作為診斷PH患者的無創(chuàng)檢測(cè)方法。 2.研究選用的超聲心動(dòng)圖測(cè)量肺血管阻力方法,所需參變量少且易獲得,值得臨床推廣應(yīng)用,其中以TRV/VTIrvot的相關(guān)性最高。 3.患者行超聲心動(dòng)圖時(shí),若PASP35mmHg的患者,可常規(guī)測(cè)量PVR�；颊呷缬辛己玫娜獍攴戳黝l譜,可選用TRV/VTIrvot;若患者無法獲得清晰的三尖瓣反流頻譜,但有清晰的肺動(dòng)脈瓣反流頻譜,此時(shí)可選用PIV/VTIpa。
[Abstract]:Objective: right cardiac catheterization is the gold standard for the measurement of pulmonary vascular resistance (Pulmonary vascular resistance, PVR). In this study, non-invasive Doppler echocardiography was used to measure PVR and the results were compared with that of right cardiac catheterization (Right-heart catheterization, RHC). To evaluate the accuracy of ultrasonic measurement. Methods: 29 patients (PASP35mmHg) with pulmonary arterial systolic blood pressure (PASP35mmHg) were examined by echocardiography (Ultrasonic cardiogram, UCG) in the first affiliated Hospital of Kunming Medical University on March 12, 2013. The patients were examined by Doppler echocardiography. The ratio of tricuspid regurgitation velocity to right ventricular outflow tract velocity / area product ratio (TRV/VArvot), tricuspid regurgitation velocity to right ventricular outflow tract time integral ratio (TRV/VTIrvot), pulmonary valve maximal reflux velocity to pulmonary artery flow velocity time integral (PIV/VTIpa) and tricuspid valve flow velocity time integral (PIV/VTIpa) and tricuspid apex were used. Pulmonary vascular resistance was measured by valve regurgitation pressure difference and left ventricular outflow tract time-velocity integral ratio (TRV/VTlvot). Pulmonary vascular resistance was measured by right cardiac catheterization, pulmonary artery systolic pressure, pulmonary diastolic pressure, (Pulmonary artery diastolic pressure PADP), pulmonary artery mean pressure, (pulmonary artery mean pressure, PAMP), pulmonary capillary wedge pressure (Pulmonary capillary wedge pressure PCWP). Were recorded. Pulmonary blood flow (QP) was calculated by Fick method, and PVR was calculated according to Poiseuille formula PVR = (PAMP-PC WP) / QP. Linear regression analysis and Bland-Altman analysis were performed between the four methods of echocardiography and the results of pulmonary vascular resistance measurement by right cardiac catheterization. Results: there was a positive correlation between pulmonary vascular resistance measured by four kinds of Doppler echocardiography and pulmonary vascular resistance measured by right cardiac catheterization (r = 0.71 鹵0.766). The correlation between TRV/VTIrvot method and right cardiac catheterization was the highest. Bland-Altman method was used to analyze the correlation between PVR and right cardiac catheterization. PVR was measured in 95% confidence interval (-1.13 WU) for PVR and 95% for right cardiac catheterization (-1.01WU, 1.01WU). PVR measured by PIV/VTIpa and PVR measured by right cardiac catheterization within 95% confidence interval (-1.10WUU 1.10WU), PVR measured by TRV / VT Ilvot and PVR measured by right cardiac catheterization were within 95% confidence interval (-1.21WU). Conclusion 1. Pulmonary vascular resistance was estimated by Doppler echocardiography and pulmonary vascular resistance was measured by right cardiac catheterization. The correlation coefficient is 0.69 ~ 0.76. Doppler echocardiography can be used as a noninvasive method for the diagnosis of PH. 2. The method of echocardiography used to measure pulmonary vascular resistance needs less variables and is easy to obtain, which is worth popularizing in clinical application, in which TRV/VTIrvot has the highest correlation. In patients undergoing echocardiography, PVR can be measured routinely in patients with PASP35mmHg. If the patients have good tricuspid regurgitation spectrum, TRV / VTIrvot can be selected; if the patient can not obtain a clear tricuspid regurgitation spectrum, but has a clear pulmonary regurgitation spectrum, PIVP / VTIpa.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R540.45;R544.1
[Abstract]:Objective: right cardiac catheterization is the gold standard for the measurement of pulmonary vascular resistance (Pulmonary vascular resistance, PVR). In this study, non-invasive Doppler echocardiography was used to measure PVR and the results were compared with that of right cardiac catheterization (Right-heart catheterization, RHC). To evaluate the accuracy of ultrasonic measurement. Methods: 29 patients (PASP35mmHg) with pulmonary arterial systolic blood pressure (PASP35mmHg) were examined by echocardiography (Ultrasonic cardiogram, UCG) in the first affiliated Hospital of Kunming Medical University on March 12, 2013. The patients were examined by Doppler echocardiography. The ratio of tricuspid regurgitation velocity to right ventricular outflow tract velocity / area product ratio (TRV/VArvot), tricuspid regurgitation velocity to right ventricular outflow tract time integral ratio (TRV/VTIrvot), pulmonary valve maximal reflux velocity to pulmonary artery flow velocity time integral (PIV/VTIpa) and tricuspid valve flow velocity time integral (PIV/VTIpa) and tricuspid apex were used. Pulmonary vascular resistance was measured by valve regurgitation pressure difference and left ventricular outflow tract time-velocity integral ratio (TRV/VTlvot). Pulmonary vascular resistance was measured by right cardiac catheterization, pulmonary artery systolic pressure, pulmonary diastolic pressure, (Pulmonary artery diastolic pressure PADP), pulmonary artery mean pressure, (pulmonary artery mean pressure, PAMP), pulmonary capillary wedge pressure (Pulmonary capillary wedge pressure PCWP). Were recorded. Pulmonary blood flow (QP) was calculated by Fick method, and PVR was calculated according to Poiseuille formula PVR = (PAMP-PC WP) / QP. Linear regression analysis and Bland-Altman analysis were performed between the four methods of echocardiography and the results of pulmonary vascular resistance measurement by right cardiac catheterization. Results: there was a positive correlation between pulmonary vascular resistance measured by four kinds of Doppler echocardiography and pulmonary vascular resistance measured by right cardiac catheterization (r = 0.71 鹵0.766). The correlation between TRV/VTIrvot method and right cardiac catheterization was the highest. Bland-Altman method was used to analyze the correlation between PVR and right cardiac catheterization. PVR was measured in 95% confidence interval (-1.13 WU) for PVR and 95% for right cardiac catheterization (-1.01WU, 1.01WU). PVR measured by PIV/VTIpa and PVR measured by right cardiac catheterization within 95% confidence interval (-1.10WUU 1.10WU), PVR measured by TRV / VT Ilvot and PVR measured by right cardiac catheterization were within 95% confidence interval (-1.21WU). Conclusion 1. Pulmonary vascular resistance was estimated by Doppler echocardiography and pulmonary vascular resistance was measured by right cardiac catheterization. The correlation coefficient is 0.69 ~ 0.76. Doppler echocardiography can be used as a noninvasive method for the diagnosis of PH. 2. The method of echocardiography used to measure pulmonary vascular resistance needs less variables and is easy to obtain, which is worth popularizing in clinical application, in which TRV/VTIrvot has the highest correlation. In patients undergoing echocardiography, PVR can be measured routinely in patients with PASP35mmHg. If the patients have good tricuspid regurgitation spectrum, TRV / VTIrvot can be selected; if the patient can not obtain a clear tricuspid regurgitation spectrum, but has a clear pulmonary regurgitation spectrum, PIVP / VTIpa.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R540.45;R544.1
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相關(guān)期刊論文 前10條
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