本文選題：慢性肺心病　切入點：超聲心動圖　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:慢性肺心病是一種老年人常見的多發(fā)病。目前對于慢性肺心病的主要是維持治療,改善患者的生存狀態(tài)。因此,對于患者的早期診斷就顯得尤為重要。在慢性肺心病的診斷中,主要是依靠患者的臨床表現(xiàn)、體格檢查、心電圖等的輔助檢查,缺乏特異的實驗室依據(jù)。血漿腦鈉肽(B-type natriurefic peptide,BNP)與心臟負(fù)荷之間有很好的相關(guān)性,血漿N末端腦鈉肽(N-terminal pro-brain natriuretic peptide,NT-pro BNP)是BNP激素原分裂后沒有活性的N-末端片段,與BNP相比,半衰期更長,更穩(wěn)定,更能反映BNP通路的激活,血漿NT-pro BNP水平隨心衰程度加重而升高。超聲心動圖作為一種無創(chuàng)、重復(fù)性好的檢測方法,對于心臟和血管的功能能夠起到有效的監(jiān)測。本研究采用心臟超聲檢測指南推薦的右心收縮功能相關(guān)指標(biāo)(TAPSE、Tei指數(shù)),評價肺心病對右心室收縮功能和肺動脈高壓的影響,并通過與NT-pro BNP的比較,探討上述指標(biāo)在肺心病發(fā)生發(fā)展過程中的演變規(guī)律及其臨床指導(dǎo)意義,為肺心病的診斷提供了一種簡便、無創(chuàng)、可靠的方法。方法:對我院收集確定為慢性肺心病患者176例進(jìn)行分組,其中慢性肺心病代償期組(57例)和慢性肺心病失代償期組(119例),并將慢性肺心病失代償期組分為呼吸困難期組(42例)、右心衰竭期組(55例)和全心衰竭期組(22例)。同時選擇正常對照組(門診健康人群,30例)。分組后24小時內(nèi)使用電化學(xué)發(fā)光法檢測患者血清中NT-Pro BNP濃度,同時使用彩色多普勒超聲診斷儀檢測患者三尖瓣環(huán)收縮期位移,觀察右室Tei指數(shù)。根據(jù)簡化的Bemoulli公式和估測的右房壓(RAP)計算出肺動脈收縮壓。結(jié)果:1 NT-Pro BNP檢測肺心病代償期患者為301.34±43.22pg/ml,慢性肺心病失代償期呼吸困難組為734.12±52.32 pg/ml,右心衰竭組為2134.45±521.42 pg/ml,全心衰竭組為6345.56±3621.82 pg/ml,正常體檢患者為142.42±23.12pg/ml。(1)正常對照組和慢性肺心病疾病組存在差異,差異具有統(tǒng)計學(xué)意義(P0.01);(2)慢性肺心病疾病組之間兩兩比較發(fā)現(xiàn),失代償期和代償期之間存在差異,具有統(tǒng)計學(xué)意義(P0.01);(3)慢性肺心病失代償期各組之間,NT-pro BNP含量差異具有統(tǒng)計學(xué)意義(P0.01)。2三尖瓣環(huán)收縮期位移結(jié)果正常對照組為22.72±2.01mm,慢性肺心病代償期組為20.12±3.23mm,慢性肺心病失代償期呼吸困難組為17.34±2.73mm,右心衰竭組為12.14±2.47mm,全心衰竭組為8.21±1.32mm。(1)代償期組與正常對照組之間存在差異,具有統(tǒng)計學(xué)意義(P0.01);(2)代償期和失代償期相比較,差異具有統(tǒng)計學(xué)意義(P0.01);(3)失代償期,呼吸困難組、右心衰竭組及全心衰竭組之間有差異,差異具有統(tǒng)計學(xué)意義(P0.01)3右室Tei指數(shù)正常對照組為0.32±0.06,慢性肺心病代償期組為0.49±0.12,慢性肺心病失代償期呼吸困難組為0.64±0.11,右心衰竭組為0.72±0.15,全心衰竭組為0.91±0.13。(1)在正常對照組和慢性肺心病之間,Tei值之間具有差異,差異具有統(tǒng)計學(xué)意義(P0.01);(2)在慢性肺心病代償期和失代償期之間,Tei也具有差異(P0.01);(3)在慢性肺疾病失代償期的各組之間,Tei值也具有顯著差異(P0.01)。4肺動脈收縮壓(PASP)正常對照組為23.56±3.10mm Hg,慢性肺心病代償期為32.45±5.25mm Hg,慢性肺心病失代償期呼吸困難組為36.45±4.02mm Hg,右心衰竭組為44.12±3.45mm Hg,全心衰竭組為58.34±6.23mm Hg。(1)通過對正常組和慢性肺心病患者肺動脈壓比較,兩者之間存在差異,差異具有統(tǒng)計學(xué)意義(P0.01);(2)在慢性肺心病代償期和失代償期之間,肺動脈壓之間具有差異(P0.01);(3)在慢性失代償期組內(nèi)之間兩兩比較,肺動脈壓之間具有統(tǒng)計學(xué)意義(P0.01)。相關(guān)性分析中,腦鈉肽N末端片段和右室Tei指數(shù)、肺動脈收縮壓、三尖瓣環(huán)收縮期位移具有顯著性相關(guān)(P0.01)。腦鈉肽N末端片段與右室Tei指數(shù)Pearson系數(shù)為0.583,與肺動脈收縮壓Pearson系數(shù)為0.675,與三尖瓣環(huán)收縮期位移Pearson系數(shù)為-0.609。在對肺動脈壓和右室Tei指數(shù)、三尖瓣環(huán)收縮期位移相關(guān)性進(jìn)行分析,肺動脈壓與三尖瓣環(huán)收縮期位移和右室Tei指數(shù)Pearson系數(shù)分別為-0.775、0.699,顯著性相關(guān)(P0.01)。結(jié)論:1疾病組中NT-Pro BNP濃度高于健康組,且隨著疾病的進(jìn)展程度,濃度出現(xiàn)上升,提示NT-Pro BNP能夠有效反應(yīng)慢性肺心病疾病變化。2三尖瓣環(huán)收縮期位移、右室Tei指數(shù)以及肺動脈壓可以作為衡量疾病情況的有效指標(biāo)。三尖瓣環(huán)收縮期位移、右室Tei指數(shù)以及肺動脈收縮壓能夠有效的檢測患者右心功能變化,對于慢性肺心病早期診斷具有重要意義。3 NT-Pro BNP濃度和三尖瓣環(huán)收縮期位移、右室Tei指數(shù)以及肺動脈收縮壓具有明顯相關(guān)性,可以作為一種聯(lián)合檢測標(biāo)準(zhǔn),以提高慢性肺心病診斷手段。
[Abstract]:Objective: chronic pulmonary heart disease is a common disease in the elderly. The chronic pulmonary heart disease is mainly maintenance treatment, improving the living condition of patients. Therefore, it is particularly important for the early diagnosis of patients. In the diagnosis of chronic pulmonary heart disease, mainly depends on the clinical manifestation, patients with physical examination, auxiliary check the electrocardiogram, the lack of specific laboratory evidence. Plasma brain natriuretic peptide (B-type natriurefic, peptide, BNP) has a good correlation with cardiac load between terminal brain natriuretic peptide plasma N (N-terminal pro-brain natriuretic peptide, NT-pro BNP) is a N- terminal fragment of BNP prohormone split after no activity, compared with BNP. The half-life is longer, more stable, more can reflect the activation of BNP pathway, the level of plasma NT-pro BNP level of heart failure increased. Echocardiography is a noninvasive detection method with good reproducibility, for the heart The dirty and vascular function can play an effective monitoring. This study by echocardiography right ventricular systolic function related indexes recommended (TAPSE, Tei index), impact assessment of right ventricular systolic function of pulmonary heart disease and pulmonary hypertension, and compared with NT-pro BNP, to explore the significance of the above indexes were evolution in the process of development and clinical guidance in the diagnosis for pulmonary heart disease, pulmonary heart disease provides a simple, noninvasive and reliable method. Methods: collected in our hospital to determine 176 cases of patients with chronic pulmonary heart disease were divided into two groups, including decompensated chronic pulmonary heart disease group (57 cases) and chronic cor pulmonale. Group (119 cases), and chronic decompensated pulmonary heart disease were divided into dyspnea group (42 cases), right heart failure group (55 cases) and heart failure group (22 cases) and normal control group. (30 cases of Men Zhenjian Kang people). After 24 hours of packet The use of electrochemical NT-Pro BNP concentration in serum of patients with chemiluminescence detection, at the same time the use of color Doppler ultrasonography in three patients with tricuspid annular systolic displacement observation, right ventricular Tei index. According to the Bemoulli equation and the estimation of right atrial pressure (RAP) to calculate the pulmonary artery systolic pressure. Results: 1 patients with NT-Pro BNP detection decompensated pulmonary heart disease was 301.34 + 43.22pg/ml, in patients with chronic cor pulmonale. Dyspnea group was 734.12 + 52.32 pg/ml, right heart failure group was 2134.45 + 521.42 pg/ml, heart failure group was 6345.56 + 3621.82 pg/ml, patients with normal physical examination was 142.42 + 23.12pg/ml. (1) normal control group and chronic pulmonary heart disease group differences, the difference was statistically significant (P0.01); (2) between chronic lung disease group 22 comparison, there are differences between decompensated and decompensated, with statistical significance (P0.01); (3) chronic pulmonary heart disease Between the decompensated group, the difference was statistically significant NT-pro the content of BNP (P0.01).2 three tricuspid annular systolic displacement in the normal control group was 22.72 + 2.01mm, decompensated chronic pulmonary heart disease group was 20.12 + 3.23mm, in patients with chronic cor pulmonale. Dyspnea group was 17.34 + 2.73mm, right heart failure group was 12.14 + 2.47mm, heart failure group was 8.21 + 1.32mm. (1) there are differences between the decompensated group and normal control group, with statistical significance (P0.01); (2) during compensatory and compared, the difference was statistically significant (P0.01); (3) loss compensation period, dyspnea group, there are differences between right heart failure group and heart failure group, the difference was statistically significant (P0.01) 3 right ventricular Tei index in normal control group is 0.32 + 0.06, decompensated chronic pulmonary heart disease group is 0.49 + 0.12, chronic decompensated pulmonary heart disease dyspnea group was 0.64 + 0.11, right heart failure group is 0.72 + 0.15, full The heart failure group was 0.91 + 0.13. (1) between the control group and the chronic pulmonary heart disease with different Tei values, the difference was statistically significant (P0.01); (2) in decompensated chronic pulmonary heart disease and decompensation, Tei also has the difference (P0.01); (3) between the groups in chronic decompensated pulmonary disease, the Tei value also has significant difference (P0.01).4 pulmonary artery systolic pressure (PASP) and normal control group was 23.56 + 3.10mm Hg, decompensated chronic pulmonary heart disease was 32.45 + 5.25mm Hg in patients with chronic cor pulmonale. Dyspnea group was 36.45 + 4.02mm Hg, right heart failure group 44.12 + 3.45mm Hg, heart failure group was 58.34 + 6.23mm Hg. (1) through the pressure of the normal group and chronic pulmonary heart disease in patients with pulmonary artery, differences between the two, the difference was statistically significant (P0.01); (2) in decompensated chronic pulmonary heart disease and decompensation, pulmonary artery with pressure differences between (P0.01) (3); The comparison of 22 chronic decompensated group, pulmonary artery pressure was statistically significant (P0.01). The correlation analysis of brain natriuretic peptide, N terminal fragment and Tei index of right ventricular and pulmonary artery systolic pressure, three tricuspid annular systolic displacement has significant correlation (P0.01). Brain natriuretic peptide and N terminal fragment right ventricular Tei index Pearson index is 0.583, and the pulmonary artery systolic pressure coefficient of Pearson was 0.675, and the systolic displacement of tricuspid valve ring three Pearson coefficient -0.609. on pulmonary artery pressure and right ventricular Tei index, three tricuspid annular systolic displacement correlation analysis, pulmonary artery pressure and three tricuspid annulus and right ventricular systolic displacement the Tei index Pearson coefficient was -0.775,0.699, significant correlation (P0.01). Conclusion: 1 NT-Pro BNP disease group was significantly higher than that in healthy group, and with the progress of disease, the concentration increased, suggesting that NT-Pro BNP can effectively be chronic pulmonary heart disease The change of.2 three tricuspid annular systolic displacement, right ventricular Tei index and pulmonary artery pressure can be used as an effective indicator of disease. Three tricuspid annular systolic displacement, right ventricular Tei index and pulmonary artery systolic pressure can detect changes of right ventricular function in patients with effective, is of great significance for the.3 NT-Pro BNP concentration and three tricuspid valve ring systolic displacement in early diagnosis of chronic pulmonary heart disease, right ventricular Tei index and pulmonary artery systolic pressure was significantly correlated with, can be used as a joint detection standard, in order to improve the diagnosis of chronic pulmonary heart disease.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李靜;梁燕玲;羅雪清;;彩色多普勒超聲心動圖用于診斷肺源性心臟病的臨床價值[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年19期

2 石志敏;姜志榮;呂啟鳳;王小凡;;BNP及斑點追蹤成像對右心室功能改變的評價價值[J];青島大學(xué)醫(yī)學(xué)院學(xué)報;2016年04期

3 朱麗敏;;血清肌鈣蛋白T、心肌酶及白介素-6聯(lián)合檢測對慢性心力衰竭患者的作用分析[J];中國醫(yī)藥科學(xué);2016年15期

4 沈文富;耿艷鳴;姜正華;;慢性阻塞性肺疾病患者血漿氨基末端腦鈉肽前體水平與肺動脈壓的相關(guān)性[J];實用臨床醫(yī)藥雜志;2016年13期

5 徐志偉;趙文強(qiáng);程志祥;;慢性肺源性心臟病患者血N末端B型鈉尿肽和超敏C反應(yīng)蛋白水平的臨床意義[J];中西醫(yī)結(jié)合心血管病電子雜志;2015年33期

6 田利榮;韓梅;姜吉勇;;肺源性心臟病患者膽堿酯酶、前白蛋白、C-反應(yīng)蛋白水平變化的臨床分析[J];中國衛(wèi)生檢驗雜志;2016年10期

7 舒思亮;;慢性肺心病急性發(fā)作期與緩解期血清超敏C反應(yīng)蛋白、心肌酶水平的變化[J];健康研究;2016年02期

8 張雪峰;;肺心病的臨床診療分析[J];世界最新醫(yī)學(xué)信息文摘;2016年28期

9 高喜君;;血清甲狀腺激素水平對肺心病合并右心衰竭患者的臨床意義[J];國際呼吸雜志;2016年06期

10 單長波;范建新;;慢性阻塞性肺疾病致右心衰竭NT-proBNP水平和Tei指數(shù)相關(guān)性[J];國際呼吸雜志;2016年05期

相關(guān)博士學(xué)位論文 前1條

1 徐勇;超聲心動圖對急性心肌梗死患者PCI術(shù)后的量效觀察[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2006年

相關(guān)碩士學(xué)位論文 前3條

1 趙明明;慢性心力衰竭患者血漿腦鈉肽水平與心衰超聲指數(shù)的臨床研究[D];蚌埠醫(yī)學(xué)院;2015年

2 李妍;二維及三維超聲心動圖多指標(biāo)評價肺栓塞規(guī)范治療后右心形態(tài)和功能的研究[D];福建醫(yī)科大學(xué);2013年

3 張美琴;慢性肺心病病人右室組織多普勒Tei指數(shù)的研究[D];山西醫(yī)科大學(xué);2007年

，

本文編號：1598049