彩色多普勒超聲檢測肺血管阻力的價值
發(fā)布時間：2018-07-31 17:01
【摘要】：目的：右心導管術(shù)目前是測量肺血管阻力(Pulmonary vascular resistance, PVR)的金標準,但因其為創(chuàng)傷性檢查操作復雜,費用較高,本研究用多普勒超聲心動圖無創(chuàng)測量PVR,并與右心導管術(shù)(Right-heart catheterization, RHC)結(jié)果比較。評價超聲測量的準確性。 方法：選取2013.01～2013.12在昆明醫(yī)科大學第一附屬醫(yī)院心臟彩超室行超聲心動圖(Ultrasonic cardiogram, UCG)檢查有肺動脈收縮壓(Pulmonary artery systolic pressure, PASP)升高者(PASP35mmHg)29例�；颊咝卸嗥绽粘曅膭訄D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間流速積分比(TRV/VTIrvot);肺動脈瓣最大反流速度與肺動脈血流速度時間積分(PIV/VTIpa)及三尖瓣反流壓差與左室流出道時間流速積分比(TRV/VTlvot)測量肺血管阻力。對該部分同時行右心導管術(shù)測量肺血管阻力,記錄肺動脈收縮壓、肺動脈舒張壓(Pulmonary artery diastolic pressure PADP)、肺動脈平均壓(pulmonary artery mean pressure, PAMP)、肺毛細血管楔壓(Pulmonary capillary wedge pressure PCWP)。根據(jù)Fick法計算肺血流量QP,再根據(jù)Poiseuille公式PVR=(PAMP-PC WP)/QP計算出PVR。超聲心動圖組四種測量方法分別與右心導管法肺血管阻力測量結(jié)果組進行線性回歸分析及Bland-Altman分析。 結(jié)果：四種多普勒超聲心動圖測量的肺血管阻力值與右心導管測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測量PVR與右心導管測量PVR在95%的可信區(qū)間(-1.13WU～1.13WU)內(nèi)：TRV/VTIrvot測量PVR與右心導管測量PVR在95%的可信區(qū)間(-1.01WU～1.01WU)內(nèi)；PIV/VTIpa測量PVR與右心導管測量PVR在95%的可信區(qū)間(-1.10WU～1.10WU)內(nèi)；TRV/VTIlvot測量PVR與右心導管測量PVR在95%的可信區(qū)間(-1.21WU～1.21WU)內(nèi)。 結(jié)論：1.多普勒超聲心動圖估測肺血管阻力和右心導管術(shù)測量肺血管阻力,兩者的結(jié)果呈高度相關(guān)性,相關(guān)系數(shù)為0.69～0.76,多普勒超聲心動圖可作為診斷PH患者的無創(chuàng)檢測方法。 2.研究選用的超聲心動圖測量肺血管阻力方法,所需參變量少且易獲得,值得臨床推廣應用,其中以TRV/VTIrvot的相關(guān)性最高。 3.患者行超聲心動圖時,若PASP35mmHg的患者,可常規(guī)測量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,但有清晰的肺動脈瓣反流頻譜,此時可選用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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R540.45;R544.1
【參考文獻】
相關(guān)期刊論文 前10條
1 徐崢嶸;黃新勝;黃奕高;黃濤;黃文輝;張曹進;申俊君;;超聲心動圖定量評估先天性心臟病患者肺血流量的研究[J];南方醫(yī)科大學學報;2010年05期
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