超声心动图评价肺栓塞患者右心室功能

摘要

目的 运用二维超声心动图(2DE)、组织多普勒成像(TDI)、实时三维超声心动图(RT-3DE),评估肺栓塞(PE)患者右心室形态及功能改变,并探讨其准确性、敏感性及优越性.方法 正常对照组30例,肺栓塞组28例,依据预期的PE相关早期病死率进行危险分层为:高危、中危、低危亚组.所有研究对象行2DE测量右心室常规超声指标,TDI测算右心室Tei指数,RT-3DE测量右心室舒张期末及收缩期末容积、每搏输出量和射血分数(RVEDV、RVESV、RVSV、RVEF).结果 与对照组相比,PE高危组右房室增大及肺动脉压显著升高,右室Tei指数、RVEDV、RVESV明显增大(P＜0.05),RVEF明显减小(P＜0.05)；中危组虽无明显右房室增大,但右室Tei指数、RVEDV、RVESV、RVEF均出现异常(P＜0.05)；低危组上述指标与对照组比较无统计学差异(P＞0.05).中危组右室Tei指数、RVEDV、RVESV大于低危组而小于高危组,RVEF小于低危组而大于高危组.结论 肺栓塞患者右心室功能可出现不同程度受损；TDI测算右室Tei指数和RT 3DE测量RVEF可客观、准确、较敏感地反映右室功能的变化,是评价肺栓塞患者右室功能的较好指标.%Objective To evaluate right ventricular function in patients with pulmonary embolism (PE) using two-dimensional echocardiography (2DE), tissue Doppler imaging (TDD and real-time three-dimensional echocardio-graphy (RT-3DE). Methods Twenty-eight patients with pulmonary embolism were divided into three subgroups as: high risk group, moderate risk group and low risk group, according to the expected PE-related early mortality. Thirty normal subjects were selected as control group. Traditional parameters of right heart diameter by 2DE. right ventricular Tei index by TDI, RVEDV, RVESV, RVSV and RVEF by RT-3DE were evaluated in all subjects. Results Compared with the control group, Tei index, RVEDV and RVESV of high risk PE group were significantly increased (P< 0. 05), RVEF was significantly decreased (P<0. 05), as well as characteristic appearance of right ventricular dilation and severe pulmonary hypertension. In moderate risk PE group, Tei index, RVEDV, RVESV and RVEF also showed obvious difference (P<0. 05), in spite of no dilated right ventricle. Besides, Tei index, RVEDV, RVESV were bigger than those of low risk group but smaller than those in high risk group. While RVEF was smaller than that of low risk group but bigger than that in high risk group. There was no significant difference in low risk PE group (P> 0. 05). Conclusions Variations of right ventricular morphology and function in pulmonary embolism can be detected byrnechocardiography. right ventricular Tei index by TDI and RVEF from RT-3DE were objective, accurate and sensitive indicators for right ventricular global function.