摘要
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。
Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) 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-3 DE 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-3 DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.
引文
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