摘要
目的探讨三尖瓣瓣环组织位移技术对于房间隔缺损伴不同程度肺动脉高压患者右心室功能变化评估。方法选择2010至2015年诊断房间隔缺损伴不同肺动脉高压患者62例。依据患者合并肺动脉高压水平不同分为正常组(静息时肺动脉压<30 mm Hg)18例、轻度组(静息时肺动脉压30~40 mm Hg)23例与中度组21例(静息时肺动脉压>40 mm Hg)。经胸二维超声及三维超声检查测量3组患者右心室舒张末期内径(RVEDd)、右心房横径(RALD)与右心室舒张末容积(EDV)、右心室收缩末期容积(ESV)、右心室射血分数(RVEF),采用斑点追踪技术测量右心室侧壁三尖瓣前叶瓣环与瓣环室间隔处二者连线中点相对于心尖部收缩期位移峰值距离(TAD),电化学发光法测定血浆氨基末端钠尿肽(NT-proBNP)水平。采用Pearson相关检验分析TAD与RVEF、血浆NT-proBNP水平相关性。结果中度组、轻度组与正常组患者RVEDd、RALD逐渐降低,EDV、RVEF增加,ESV减少,3组比较差异有统计学意义(P<0.05)。正常组、轻度组与中度组TAD逐渐减少,NT-proBNP水平逐渐增加,3组比较差异均有统计学意义(P<0.05)。右心室三尖瓣瓣环位移距离越小,右心室收缩功能越差,肺动脉压(sPAP)与血浆NT-proBNP水平越高。TAD与RVEF呈正相关(r=0.684,P<0.05);TAD与sPAP呈负相关(r=-0.806,P<0.05);TAD与血浆NT-proBNP水平呈负相关(r=-0.732,P<0.05)。结论房间隔缺损伴有不同程度肺动脉高压患者右心室受损程度存在差异。右心室收缩期三尖瓣环位移与射血分数、肺动脉压、血浆氨基末端钠尿肽水平存在相关性。常规测量右心室收缩期三尖瓣环位移峰值可以有效定量评估房间隔缺损患者右心室负荷变化。
Objective To investigate the changes of right ventricular function in patients with atrial septal defect(ASD)complicated by pulmonary hypertension.Methods A total of 62 patients with ASD complicated by pulmonary hypertension who were diagnosed and treated in our hospital from 2010 to 2015 were enrolled in the study.According to the different levels of pulmonary hypertension,the patients were divided into control group(pulmonary artery pressure at rest<30mmHg,n=18),mild group(pulmonary artery pressure at rest 30mmHg^40mmHg,n=23),and moderate group(pulmonary artery pressure at rest>40mmHg,n=21).The right ventricular end diastolic diameter(RVEDd),right atrial transverse diameter(RALD),right ventricular end diastolic volume(EDV),right ventricular end systolic volume(ESV)and right ventricular ejection fraction(RVEF)were measured by two-dimensional and three-dimensional echocardiography.The midpoint of the line between the anterior tricuspid annulus and the interventricular septum of the annulus was measured by spot tracking technique.Moreover the peak systolic displacement distance(TAD,mm)and the levels of NT proBNP in plasma were detected by electrochemiluminescence.Pearson correlation test was performed to analyze the correlation between TAD,RVEF and NT proBNP.Results The levels of RVEDd,RALD and TAD in control group,mild group and moderate group were decreased gradually,however,the levels of EDV,RVEF and NT-proBNP were increased gradually,there were significant differences among the three groups(P<0.05).The smaller the displacement distance of right ventricular tricuspid annulus,the worse the systolic function of right ventricle,the higher the levels of pulmonary artery pressure(SPAP)and plasma NT proBNP.In addition TAD was positivelt correlated with RVEF(P<0.05),however,the TAD was negativelt correlated with sPAP(P<0.05),moreover,the TAD levels were negativelt correlated with plasma NT proBNP(P<0.05).Conclusion The severity of right ventricular damage is different in patients with ASD complicated by pulmonary hype
作者
石银华
吴伟
杨明华
王晓洁
谷昆峰
殷珊珊
SHI Yinhua;WU Wei;YANG Minghua(Department of Heart Large Vessels Surgery,People’s Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050031,China)
出处
《河北医药》
CAS
2020年第22期3452-3455,共4页
Hebei Medical Journal
基金
石家庄市科学技术研究与发展指导计划(编号:151460603)。
关键词
房间隔缺损
右心室
心功能
超声心动图
肺动脉高压
atrial septal defect
right ventricle
heart function
ultrasoundcardiogram
pulmonary hypertension
