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中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (09) : 664 -670. doi: 10.3877/cma.j.issn.1672-6448.2017.09.007

所属专题： 文献；

心血管超声影像学

实时三维超声心动图评价肺动脉高压患者右心结构及血流动力学的价值
陈勇1,†(), 马勇1, 袁静1, 于海迪1, 杨菲1, 陈银花1, 吴秀秀1   
  1. 1. 225001　扬州，江苏省苏北人民医院超声心动图室
  • 收稿日期:2017-03-01 出版日期:2017-09-01
  • 通信作者: 陈勇
  • 基金资助:
    扬州市社会发展项目(YZ2016075)

Value of real-time three-dimensional echocardiography in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension

Yong Chen1,†(), Yong Ma1, Jing Yuan1, Haidi Yu1, Fei Yang1, Yinhua Chen1, Xiuxiu Wu1   

  1. 1. Department of Echocardiography, Northern Jiangsu People′s Hospital, Yangzhou 225001, China
  • Received:2017-03-01 Published:2017-09-01
  • Corresponding author: Yong Chen
  • About author:
    Corresponding author: Chen Yong, Email:
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引用本文：

陈勇, 马勇, 袁静, 于海迪, 杨菲, 陈银花, 吴秀秀. 实时三维超声心动图评价肺动脉高压患者右心结构及血流动力学的价值[J]. 中华医学超声杂志（电子版）, 2017, 14(09): 664-670.

Yong Chen, Yong Ma, Jing Yuan, Haidi Yu, Fei Yang, Yinhua Chen, Xiuxiu Wu. Value of real-time three-dimensional echocardiography in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(09): 664-670.

目的

探讨实时三维超声心动图（RT-3DE）评价肺动脉高压（PH）患者右心结构及血流动力学的价值。

方法

选取2014年7月至2016年12月江苏省苏北人民医院收治的PH患者89例。另选取同期健康体检者49名作为健康对照组。根据肺动脉收缩压（PASP）将89例PH患者分为轻度PH29例、中度PH32例和重度PH28例。采用RT-3DE测量所有受检者右心结构相关参数，包括右心室横径（RVTD）、左心室横径（LVTD）、右心室整体舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、右心室射血分数（RVEF）及血流动力学参数，包括肺动脉收缩压（SPAP）、肺动脉舒张压（DPAP）、肺动脉平均压（MPAP）、右心输出量（RCO）。采用独立样本t检验比较PH组患者与健康对照组受检者右心结构相关参数、血流动力学参数差异；采用方差分析比较不同程度PH组患者右心结构相关参数、血流动力学参数差异，进一步组间两两比较采用SNK-q检验。

结果

PH组患者RVTD、EDV、ESV均高于健康对照组受检者，而LVTD、SV、RVEF均低于健康对照组受检者，且差异均有统计学意义（t=-2.73，P=0.003；t=-4.37，P=0.001；t=-4.57，P=0.002；t=-3.49，P=0.039；t=-2.01，P=0.043；t=6.36，P=0.001）。中度PH组、重度PH组患者RVTD、EDV、ESV均高于轻度PH组患者，而LVTD、SV、RVEF均低于轻度PH组患者，且差异均有统计学意义（q=4.318、4.713、3.873、3.921、5.127、5.347、5.618、5.903、4.318、4.501、5.327、5.981，P均<0.05）；重度PH组患者LVTD、EDV、ESV、SV、RVEF均低于中度PH组患者，RVTD高于中度PH组患者，且差异均有统计学意义（q=3.708、3.249、4.807、3.953、3.197、3.764，P均<0.05）。PH组患者SPAP、DPAP、MPAP均高于健康对照组受检者，而RCO低于健康对照组受检者，且差异均有统计学意义（t=0.637，P=0.001；t=0.875，P=0.001；t=0.783，P=0.001；t=0.691，P=0.035）。中度PH组、重度PH组患者SPAP、DPAP、MPAP均高于轻度PH组患者，重度PH组SPAP高于中度PH组患者，且差异均有统计学意义（q=4.349，P=0.041；q=5.871，P=0.039；q=4.201，P=0.042；q=4.869，P=0.043；q=3.981，P=0.034；q=3.991，P=0.035；q=0.421，P=0.039），而中度PH组与重度PH组患者DPAP、MPAP差异无统计学意义；而RCO在轻度PH组、中度PH组、重度PH组患者呈逐渐下降趋势，且任意两组间差异均有统计学意义（q=3.541，P=0.033；q=3.204，P=0.030；q=0.391，P=0.043）。

结论

PH患者右心功能减低，RT-3DE可准确评价不同程度PH患者右心功能。

关键词: 超声心动描记术，三维, 高血压，肺性, 右心结构, 血流动力学
Objective

To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension (PH).

Methods

A total of 89 PH patients in Subei People′s Hospital from July 2014 to December 2016 were selected as PH group, and 49 subjects with health examination were designed as control group. According to pulmonary arterial systolic pressure (PASP), the 89 patients with PH were divided into mild PH group (n=29), moderate PH group (n=32) and severe PH group (n=28). The indexes of right heart structure such as right ventricular diameter (RVTD), left ventricular diameter (LVTD), right ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and right ventricular ejection fraction (RVEF) as well as hemodynamic parameters such as pulmonary systolic pressure (SPAP), pulmonary artery diastolic pressure (DPAP), mean pulmonary artery pressure (MPAP) and right ventricular output (RCO) were detected by RT-3DE in all the subjects. The indexes of right heart structure and hemodynamic parameters were compared by independent-sample t test between PH group and control group, and indexes of right heart structure and hemodynamic parameters were compared by variance analysis among different PH groups. The SNK-q test was used for the further comparison between any two groups.

Results

The RVTD, EDV and ESV in the PH group were significantly higher than those in the control group, while LVTD, SV and RVEF were significantly lower than those in the control group (t=-2.73, P=0.003; t=-4.37, P=0.001; t=-4.57, P=0.002; t=-3.49, P=0.039; t=-2.01, P=0.043; t=6.36, P=0.001). The RVTD, EDV and ESV in moderate PH group and severe PH group were significantly higher than those in the mild PH group, while the LVTD, SV and RVEF were significantly lower than those in the mild PH group (q=4.318, 4.713, 3.873, 3.921, 5.127, 5.347, 5.618, 5.903, 4.318, 4.501, 5.327, 5.981, all P<0.05). The LVTD, EDV, ESV, SV, RVEF in the severe PH group were significantly lower than those in the moderate PH group, while the RVTD was significantly higher than the moderate PH group (q=3.708, 3.249, 4.807, 3.953, 3.197, 3.764, all P<0.05). The SPAP, DPAP and MPAP in PH group were significantly higher than those in control group, while RCO was significantly lower than that that in the control group (t=0.637, P=0.001; t=0.875, P=0.001; t=0.783, P=0.001; t=0.691, P=0.035). The SPAP, DPAP and MPAP in moderate PH group and severe PH group were significantly higher than those in the mild PH group, and the SPAP in the severe PH group was significantly higher than that in the moderate PH group (q=4.349, P=0.041; q=5.871, P=0.039; q=4.201, P=0.042; q=4.869, P=0.043; q=3.981, P=0.034; q=3.991, P=0.035; q=0.421, P=0.039). There were no significant differences in DPAP and MPAP between the moderate PH group and the severe PH group. The RCO decreased gradually in the mild PH group, the moderate PH group and the severe PH group, and there were significant differences between any two groups (q=3.541, P=0.033; q=3.204, P=0.030; q=0.391, P=0.043).

Conclusion

In PH patients, the right ventricular function declined, and RT-3DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.

Key words: Echocardiography, three-dimensional, Hypertension, pulmonary, Right ventricular structure, Hemodynamics
表1 PH患者与健康对照组受检者一般临床资料比较
组别 例数 性别（例，男性/女性） 年龄（岁，±s） 心率（次/min，±s）
PH组 89 59/30 51.3±7.7 84.6±16.4
健康对照组 49 29/20 49.2±6.1 71.6±9.2
检验值 ? χ2=1.524 t=2.013 t=1.607
P值 ? 0.33 0.34 0.42
表2 PH组患者与健康对照组受检者右心结构相关参数比较（±s）
组别 例数 RVTD（mm） LVTD（mm） EDV（ml） ESV（ml） SV（ml） RVEF（%）
PH组 89 46.53±7.90 31.27±4.83 107.23±37.21 67.53±29.73 32.61±20.69 34.93±9.72
健康对照组 49 30.31±3.46 35.81±2.43 92.18±33.41 51.27±22.97 41.60±19.77 57.18±10.81
t值 ? -2.73 -3.49 -4.37 -4.57 -2.01 6.36
P值 ? 0.003 0.039 0.001 0.002 0.043 0.001
图3 肺动脉平均压和舒张压估测方法。肺动脉瓣舒张期最大反流压差为34 mmHg，右心房压为10 mmHg，肺动脉平均压为44 mmHg；肺动脉瓣舒张末期反流压差为13 mmHg，右心房压为10 mmHg，肺动脉舒张压为23 mmHg
表3 不同程度PH患者右心结构相关参数比较（±s）
组别 例数 RVTD（mm） LVTD（mm） EDV（ml） ESV（ml） SV（ml） RVEF（%）
轻度PH组 29 40.31±9.02a 33.71±3.07b 87.91±35.64c 48.69±24.18d 40.47±20.81e 53.62±11.13f
中度PH组 32 42.76±8.98 32.19±3.73 110.82±40.51 72.53±33.73 37.29±21.01 41.85±12.21
重度PH组 28 44.57±8.77g 31.54±4.11h 94.29±36.91i 69.33±32.81j 29.72±13.09k 30.87±10.97l
F值 ? 15.873 16.032 14.907 15.634 15.901 16.039
P值 ? 0.041 0.032 0.037 0.020 0.045 0.023
表4 PH组患者与健康对照组受检者血流动力学参数比较（±s）
组别 例数 SPAP（mmHg） DPAP（mmHg） MPAP（mmHg） RCO（L/min）
PH组 89 83.29±20.17 57.01±29.79 46.27±12.87 3.51±1.33
健康对照组 49 22.13±3.73 10.71±2.94 15.97±2.31 5.29±1.47
t值 ? 0.637 0.875 0.783 0.691
P值 ? 0.001 0.001 0.001 0.035
表5 不同程度PH患者血流动力学参数比较（±s）
组别 例数 SPAP（mmHg） DPAP（mmHg） MPAP（mmHg） RCO（L/min）
轻度PH组 29 49.72±21.33a 43.21±28.87b 42.37±12.81c 4.99±1.13d
中度PH组 32 69.93±23.13 59.31±30.14 54.37±13.11 4.17±1.09
重度PH组 28 84.49±22.71e 56.33±29.91 55.21±12.93 3.01±1.21f
F值 ? 17.218 17.846 14.038 13.467
P值 ? 0.019 0.038 0.035 0.042
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