实时三维超声心动图评价WHO功能Ⅰ级肺动脉高压患者右心房功能

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摘要目的应用实时三维超声心动图（RT-3DE）评价WHO功能I级肺动脉高压（WHO FCⅠPH）患者右心房功能。方法选取2014年2月～2016年6月在南方医科大学附属深圳宝安医院经临床诊断为WHO FCⅠ级PH、且经胸超声心动图三尖瓣反流法估测肺动脉收缩压（PASP）≥40 mmHg的患者41例为PH组，以及一般资料相匹配并经体检证实的健康者32例为正常对照组，采集所有研究对象右心房全容积图像，导入QLAB 9.0（10.5）软件分析，得到心动周期不同时相右心房容积，并以体表面积校正，得到右心房最大容积指数（RAVImax）、最小容积指数（RAVImin）、收缩前容积指数（RAVIpre）。并通过计算得到右心房总排空容积指数（RAVIt），代表储存器功能；右心房被动排空容积指数（RAVIp），右心房被动排空分数（RAEFp），代表管道功能；右心房主动排空容积指数（RAVIa），右心房主动排空分数（RAEFa），代表助力泵功能。组织多普勒测量三尖瓣环右心室游离壁舒张期运动速度（e/a）；M型超声测量三尖瓣环右心室游离壁收缩期位移（TAPSE），Simpson法测量右心室射血分数（RVEF）。比较两组间各参数的差异。结果与正常对照组比较，PH组TAPSE、RVEF差异无统计学意义（P > 0.05），RAVImax、RAVIpre、RAVImin、RAVIt、RAVIa显著增加（P ＜ 0.05或P ＜ 0.01）,而RAVIp、RAEFp、e/a显著减低（P ＜ 0.05）。结论 WHO FCⅠPH患者右心房管道功能减低,助力泵功能和储存器功能增强，RT-3DE提供了无创性评价的新方法。

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	陈明程起李燕相广财

关键词 ：实时三维超声心动描记术, 右心房功能, 肺动脉高压

Abstract：Objective To assess right atrial function in patients with pulmonary hypertension (PH) in WHO functional classⅠ (WHO FCⅠ) using real-time three-dimensional echocardiography(RT-3DE). Methods From February 2014 to June 2016, in Affiliated Shenzhen Bao'an Hospital of Southern Medical University, 41 patients with PH in WHO FCⅠ were chosen as PH group, and 32 healthy volunteers were chosen as normal control group. RT-3DE full volume images of right atrium at apical four chamber view were collected. Right atrium volume during different cardiac cycle were acquired, and were corrected to body surface area, then right atrium maximal volume index (RAVImax)，right atrium minimal volume index (RAVImin) and right atrium pre-systolic volume index (RAVIpre) were derived from QLAB 9.0 (10.5) workstation. The following right atrium total emptying volume index (RAVIt = RAVImax-RAVImin), right atrium active emptying volume index (RAVIa = RAVIpre-RAVImin), right atrium passive emptying volume index (RAVIp = RAVImax-RAVIpre), right atrium passive emptying fraction (RAEFp = RAVIp/RAVIt×100%), right atrium active emptying fraction (RAEFa = RAVIa/RAVIt×100%) were calculated, respectively. And tricuspid annular plane systolic excursion (TAPSE) during systole were measured by M-mode echocardiography. Right ventricular ejected fraction (RVEF) was derived from 2DE Simpson. The tricuspid annulus velocity (e,a) of right ventricular free wall during diastole were recorded by tissue Doppler imaging, and e/a was calculated. Results There were no significance of RVEF, TAPSE between two groups, RAVImax,RAVImin, RAVIpre, RAVIt, RAVIa, RAEFa were greater than those of normal control group (P < 0.05 or P < 0.01), except that RAVIp, RAEFp, e/a were less than those of normal control group (P < 0.05). Conclusion Right atrial reservoir function and booster pump function increase, while right atrial conduit function decreases in WHO FCⅠPH. RT-3DE has potential ability to evaluate right atrial function.

Key words： Real-time three-dimensional echocardiography Right atrial function Pulmonary hypertension

基金资助:广东省深圳市宝安区科技计划社会公益项目（2015007）。

作者简介: 陈明（1970.8-），男，博士，主任医师；研究方向：实时三维超声心动图的临床研究。

引用本文:

陈明程起李燕相广财 . 实时三维超声心动图评价WHO功能Ⅰ级肺动脉高压患者右心房功能[J]. 中国医药导报, 2017, 14(19): 114-117.
CHEN Ming CHENG Qi LI Yan XIANG Guangcai. Assessment of right atrial function in patients with pulmonary hypertension in WHO functional class Ⅰ using real-time three-dimensional echocardiography. 中国医药导报, 2017, 14(19): 114-117.

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