摘要
目的探讨右心声学造影检测心内或肺内右向左分流的价值。方法回顾性分析中日友好医院2015年5月至2018年7月期间行右心声学造影检查的肺动脉高压患者74例临床资料。根据右心声学造影结果分为三组:心内分流组(<4个心动周期左心发现微泡)、肺内分流组(>4个心动周期内发现左心微泡)和声学造影阴性组(左心未测到微泡),比较各组间临床表现、功能分级、氧合及血流动力学特征,同时分析各组间合并神经系统并发症的差异。结果74例患者中右心声学造影阳性28例(37.8%),包括心内分流11例(14.9%),肺内分流17例(23.0%)。心内分流阳性患者中有5例(6.8%)经胸心普通超声检查为阴性,2例肺内分流患者证实为遗传性出血性毛细血管扩张症(HHT),1例为不明原因的肺动静脉畸形(PAVM)。三组患者的临床症状、世界卫生组织(WHO)心功能分级、脑钠肽前体(NT-proBNP)水平、动脉血氧分压(PO2)、肺动脉平均压(mPAP)、右房压(RAP)、肺血管阻力(PVR)、心排血量(CO)差异均无统计学意义(均P>0.05)。5例(6.8%)患者存在神经系统合并症,包括4例(5.4%)脑梗死、1例(1.4%)癫痫,其中2例患者临床评估脑梗死为心内分流继发的矛盾性栓塞。三组比较,心内分流组患者存在神经系统合并症比例更高(P<0.05)。结论右心声学造影检测右向左分流对肺动脉高压的病因诊断有补充价值,是否存在分流对患者病情严重程度无明显影响,但合并心内分流者发生神经系统并发症的风险增加。
Objective To explore the value of right heart contrast echocardiography in etiological diagnosis and severity assessment of pulmonary hypertension(PH).Methods A retrospective analysis was conducted on 74 patients who underwent transthoracic contrast echocardiography in China-Japan Friendship Hospital from May 2015 to July 2018,all of whom were diagnosed as PH by right heart catheterization.Patients were divided into three groups according to contrast echocardiography:the intra-cardiac shunt group(<4 cardiac cycles with microbubbles in the left heart);Intrapulmonary shunt group(>4 cardiac cycles with microbubbles in the left heart);non-shunt group.The etiology,partial arterial oxygen pressure(PO2),N-terminal pro-brain natriuretic peptide(NT-proBNP),mean pulmonary artery pressure(mPAP),right atrial pressure(RAP),pulmonary vascular resistance(PVR)and cardiac output(CO)were analyzed.Central nervous system complications were also compared among the three groups.Results Among the 74 patients,right-to-left shunt was found in 28 cases(37.8%)by contrast echocardiography,including 11 cases(14.9%)of intra-cardiac shunt and 17 cases(23.0%)of intrapulmonary shunt.In the 11 cases of intra-cardiac shunt,7 were diagnosed with congenital heart disease and 4 were patent foramen.Two with hereditary hemorrhagic telangiectasia(HHT)and 1 with pulmonary arteriovenous malformation(PAVM)were included in the 16 cases of intrapulmonary shunt.There was no statistical difference in PO2,mPAP,PVR,NT-proBNP,RAP,CO and functional class among the three groups(all P>0.05).A total of 5 cases(6.8%)were found with nervous system comorbidities,4 cases(5.4%)with cerebral infarction and 1 cases epilepsy,and 2 cases of cerebral infarction were diagnosed as paradoxical embolism.Nervous system complications were more common in patients with intra-cardiac shunt than in other groups.Conclusion While right-to-left shunt detected by contrast echocardiography has no relationship with disease severity,it has complementary value in the etiological diagnosis of PH
作者
和雪改
谢万木
万钧
李爱莉
翟亚楠
翟振国
He Xuegai;Xie Wanmu;Wan Jun;Li Aili;Zhai Ya'nan;Zhai Zhenguo(Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,National Clinical Research Center for Respiratory Diseases,Beijing 100029,China;Echocardiography in Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,the first Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第22期1715-1719,共5页
National Medical Journal of China
基金
中国医学科学院医学与健康科技创新工程(2018-I2M-1-003)。
关键词
肺动脉高压
声学造影
心脏导管插入术
Pulmonary hypertension
Contrast echocardiography
Heart catheterization
