多普勒测压技术在原发性肺动脉高压疗效观察中的应用

摘要

Objective:: To investigate the applicatio n of Doppler echocardiographic ultrasonography in assessing prostaglandin therap eutic effect in patients with primary pulmonary hypertension(PPH).Methods : Forty-nine patients with PPH underwent right heart catheterization and Dopp ler to measure the maximal systolic pressure gradient between the right ventricl e and right atrium (ΔP). Doppler echocardiography and catheterization data wer e compared. Patients who had drug therapy were followed up long term with Doppl er echocardiography.Results:There was no significant difference in ΔP between the data obtained from Doppler echocardiography and that from cathet erization（94.7±24.1)mmHg vs.(91.6±23.9)mmHg,P＞0.05）. Good correl ation existed between the two methods(r=0.85,P＜0.0001). Systolic pul monary pressure decreased during 24to 48 hours after the therapy（122±18)mmHg v s.(117±16)mmHg,P＜0.006）. ΔP decreased significantly in 18 patients wh o were followed up more than 330 days by Doppler echocardiography(84.1±24.1)m mHg vs.(62.7±18.2)mmHg,P＜0.01). Conclusions: Doppler echocardiography may provide precious he modynamic information for the evaluation of therapy effect of PPH patients and h igh positive correlation existed between the results obtained from Doppler echoc ardiography and right heart catheterization.%目的：评价多普勒超声心动图观察原发性肺 动脉高压（PPH）患者疗效的应用价值。方法：临床诊断为PPH患者49例，右 心导管法实时监测右房、室压及肺动脉压2～3天；在用前列环素前、后15分钟内进行超声多 普勒检查，测量三尖瓣最大返流速度，计算右房、室间压差（ΔP），并与心导管法测量结 果进行相关性分析。出院后用多普勒超声心动图随访观察药物疗效。结果：多普勒超声心动图法测定的ΔP与导管法测定结果无显著差别〔（94. 7±24.1）mmHg vs.（91.6±23.9）mmHg,P＞0.05〕。两种方法测定的ΔP呈显著 正相关（r=0.85,P＜0.0001）。用药后，24～48小时后肺动脉收缩压下降〔（12 2±18）mmHg vs.（117±16）mmHg,P＜0.006〕。随访时间超过330天的18例患者，ΔP显 著下降〔（84.1±24.1）mmHg vs.（62.7±18.2）mmHg, P＜0.01〕。结论：多普勒超声心动图测压法可为PPH患者临床药物治疗及病情分析提供宝 贵的血流动力学资料，并与心导管法有显著相关性。