彩色多普勒超声检测肺血管阻力的价值
发布时间：2018-07-31 17:01
【摘要】：目的：右心导管术目前是测量肺血管阻力(Pulmonary vascular resistance, PVR)的金标准,但因其为创伤性检查操作复杂,费用较高,本研究用多普勒超声心动图无创测量PVR,并与右心导管术(Right-heart catheterization, RHC)结果比较。评价超声测量的准确性。 方法：选取2013.01～2013.12在昆明医科大学第一附属医院心脏彩超室行超声心动图(Ultrasonic cardiogram, UCG)检查有肺动脉收缩压(Pulmonary artery systolic pressure, PASP)升高者(PASP35mmHg)29例。患者行多普勒超声心动图检查,用三尖瓣反流速度与右室流出道速度-面积乘积比(TRV/VArvot);三尖瓣反流速度与右室流出道时间流速积分比(TRV/VTIrvot);肺动脉瓣最大反流速度与肺动脉血流速度时间积分(PIV/VTIpa)及三尖瓣反流压差与左室流出道时间流速积分比(TRV/VTlvot)测量肺血管阻力。对该部分同时行右心导管术测量肺血管阻力,记录肺动脉收缩压、肺动脉舒张压(Pulmonary artery diastolic pressure PADP)、肺动脉平均压(pulmonary artery mean pressure, PAMP)、肺毛细血管楔压(Pulmonary capillary wedge pressure PCWP)。根据Fick法计算肺血流量QP,再根据Poiseuille公式PVR=(PAMP-PC WP)/QP计算出PVR。超声心动图组四种测量方法分别与右心导管法肺血管阻力测量结果组进行线性回归分析及Bland-Altman分析。 结果：四种多普勒超声心动图测量的肺血管阻力值与右心导管测量的肺血管阻力值均呈正相关(r=0.71、0.76、0.69、0.74,P0.05),其中TRV/VTIrvot法相关性最高。Bland-Altman方法分析的结果为,TRV/VArvot测量PVR与右心导管测量PVR在95%的可信区间(-1.13WU～1.13WU)内：TRV/VTIrvot测量PVR与右心导管测量PVR在95%的可信区间(-1.01WU～1.01WU)内；PIV/VTIpa测量PVR与右心导管测量PVR在95%的可信区间(-1.10WU～1.10WU)内；TRV/VTIlvot测量PVR与右心导管测量PVR在95%的可信区间(-1.21WU～1.21WU)内。 结论：1.多普勒超声心动图估测肺血管阻力和右心导管术测量肺血管阻力,两者的结果呈高度相关性,相关系数为0.69～0.76,多普勒超声心动图可作为诊断PH患者的无创检测方法。 2.研究选用的超声心动图测量肺血管阻力方法,所需参变量少且易获得,值得临床推广应用,其中以TRV/VTIrvot的相关性最高。 3.患者行超声心动图时,若PASP35mmHg的患者,可常规测量PVR。患者如有良好的三尖瓣反流频谱,可选用TRV/VTIrvot;若患者无法获得清晰的三尖瓣反流频谱,但有清晰的肺动脉瓣反流频谱,此时可选用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 卤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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：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 卤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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45;R544.1
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相关期刊论文 前10条
1 徐峥嵘;黄新胜;黄奕高;黄涛;黄文辉;张曹进;申俊君;;超声心动图定量评估先天性心脏病患者肺血流量的研究[J];南方医科大学学报;2010年05期
2 任书堂;李R，
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