摘要
目的探讨对比增强超声心动图（CEE）对晚期肝病肺内分流的临床诊断价值。方法采用对比超声的检查方法，对连续24例拟肝移植患者进行了前瞻性研究，筛查晚期肝病肺内右向左分流的发生率，并根据左心室微泡的显示程度半定量分析为1～3^＋。将CEE证实有或无肺内分流的患者分为二组，对比分析其与临床各相关因素（临床特征、肺功能检查、肝功能检查、右心室功能）的关系。结果①24例患者，10例（41．7％）CEE证实肺内右向左分流。左心宣显影异常程度1～2^＋（6例1^＋；4例2^＋）出现在右心室显影后6～10余个心动周期；②两组患者在年龄、性别、动脉血气分析、肝功能化验等检查结果差异无统计学意义（P〉0．05）；③两组间在上消化道出血（4／10vs0／14）、脾脏厚度（SP）[（65．4±13．3）mm vs（45．4±12．6）mm]对比，差异有统计学意义（P〈0．05）；④两组间在肺动脉收缩压（PASP）及右室Tei指数对比差异有统计学意义[（30．2±14．7）mm Hg vs（11．5±11．8）mmHg及（0．47±0．16 vs 0．29±0．10）；P〈0．0]。结论①晚期肝病合并肺内分流而无低氧血症的肺血管扩张（IPVD）比较常见，CEE对诊断IPVD提供了一种简便、敏感、非创伤性的早期检壹手段；②门脉高压症是发生IPVD的主要因素；③右宣Tei指数可作为评估IPVD患者右心功能的重要参数。
Objective To evaluate contrast-enhanced echocardiography（CEE） for diagnosis of intrapulmonary vascular dilatations（IPVD） in liver transplantation candidates. Methods twenty-four consecutive liver transplantation candidates without evidence of cardio or respiratory disease were studied prospectively using CEE to detect the prevalence of right-to-left shunting associated with intrapulmonary vascular dilatations（IPVD）. The relative display of the left ventricle in patients with positive CEE was qualitatively assessed with a score from 1 to 3^＋. The patients were divided into two groups： IPVD and non-IPVD. The clinical data（clinical manifestations, pulmonary function, liver function tests and right ventricular function） of the two groups were compared. Results ①There were 10（41.7%） out of 24 patients （all males） with positive CEE indicating the prevalence of intrapulmonary right-to-left shunting; 4 patients were 1^＋ ;3 patients were 2^＋. ② There was no difference in mean age,gender,arterial blood gases,pulmonary function tests and liver function tests between the two groups（ P 〉0.05）. ③There were significantly differences in upper digestive tract hemorrhage （4/10 vs 0/14; P =0. 02） and spleen thickness diameter[（65.4±13.3） mm vs （45.4±12.6） ram; P 〈0.05]. ④Pulmonary artery systolic pressure and Doppler right ventricular Tel index were significantly higher in those of CEE^＋ than in those of CEE^- [（30.2±14.7） mm Hg vs （11.5±11.8） mm Hg and （0. 47±0.16 vs 0.29±0.1） ,respectively; P 〈0.05]. Conclusions CEE is a simple, sensitive, effective, safe, non-invasive and early diagnostic method for IPVD in liver transplant candidates. The pathogenic cause of IPVD and portopulmonary hypertension（PPH） might be portal hypertension, which could happen simultaneously. Doppler RV Tei index can be used as an important parameter for evaluating RV function in liver transplant candidates with IPVD.
出处
《临床荟萃》
CAS
北大核心
2006年第9期636-639,共4页
Clinical Focus
关键词
肝移植
超声心动图描记术
肺内分流
肺血管扩张
高血压
门静脉
TEI指数
liver transplantation
echocardiography
intrapulmonary shunting
intrapulmonary vascular dilatations
hypertension, portal
Tel index
