超声心动图评价窒息儿和早产儿肺动脉压力

目的：利用超声心动图技术评价窒息儿及早产儿出生后24~48 h内的肺动脉高压发生比例及程度,为临床早期诊断治疗提供可靠依据。方法：选取2010—2011年我院诊治的新生儿254例,分为非窒息早产儿108例、窒息新生儿146例。并选取正常新生儿50例作为对照,进行多普勒超声心动图检查,对肺动脉高压程度进行比较。结果：窒息新生儿肺动脉高压发生率高于早产儿和正常新生儿,各组间差异有统计学意义（P<0.05）,过期窒息儿肺动脉高压程度高于窒息足月儿和窒息早产儿,重度窒息儿肺动脉高压严重程度高于轻度窒息儿,各组间差异有统计学意义（P<0.05）。结论：窒息新生儿和早产儿出生后24~48 h内可发生不同比例和程度的肺动脉高压,窒息新生儿肺动脉高压发生率和程度高于非窒息早产儿和正常新生儿,胎龄越大、窒息程度越重,肺高压程度越重。     

超声心动图在窒患儿和早产儿肺动脉高压治疗中的价值

目的 探讨超声心动图在窒息儿和早产儿肺动脉高压治疗中的诊断价值.方法 选取超声心动图首诊为肺动脉高压的窒息儿和早产儿175例,轻度肺动脉高压组60例,中度组97例,重度组18例,排除先天性心脏病诊断,治疗后复查超声心电图,对比分析治疗前后的肺动脉压力及右心系统参数变化.结果 各组肺动脉高压患儿治疗后肺动脉压力均低于治疗前（P〈0.01）,其中重度肺动脉高压组下降明显,治疗前后对比为（72.89±2.61） mmHg vs （35.2±2.98） mmHg,各组肺动脉收缩压均降至正常范围（〈40 mmHg）,降压效果显著,主肺动脉内径及右心室前后径较治疗前减小（P〈0.01）,其中中度肺动脉高压组减小明显,主肺动脉内径治疗前后的对比为（8.57±0.52） mm vs （6.86±0.60） mm,右心室前后径治疗前后对比为（9.38±0.57） mm vs （7.40±0.50） mm,临床治疗效果满意,各组间差异有统计学意义.结论 超声心动图能够对窒息儿和早产儿治疗前后的肺动脉压力进行客观评价,为临床早期治疗、防止肺动脉高压的进一步发展及改善预后提供指导.     

早产儿和窒息儿肺动脉高压时肺静脉血流频谱的分析

目的利用超声心动图技术对早产儿和窒息儿肺动脉高压时肺静脉血流频谱进行检测分析。方法对出生后48 h内存在肺动脉高压的早产儿和窒息儿133例(其中轻度42例,中度75例,中度16例)及正常对照组52例,利用超声多普勒技术检测对比分析肺静脉血流频谱参数变化。结果轻度肺动脉高压组肺静脉血流频谱各参数与正常组比较,差异无统计学意义(P0.05),中度和重度肺动脉高压组肺静脉频谱中心室收缩期峰值速度(Sp)值明显低于正常对照组,心室收缩期峰值速度(Dp)、心房收缩期速度和持续时间(Ar、AT)值明显高于正常对照组,差异有统计学意义(P0.05);轻、中度肺动脉高压组的二尖瓣E/A值低于正常对照组,但差异无统计学意义(P0.05),重度肺动脉高压组E/A值明显低于正常对照组,差异有统计学意义(P0.05);轻、中度肺动脉高压组的EF值低于正常对照组,但差异无统计学意义(P0.05),重度肺动脉高压组EF值明显低于正常对照组,差异有统计学意义(P0.05)。结论早产儿和窒息儿肺动脉高压时肺静脉频谱变化与肺动脉高压程度相关,肺静脉血流频谱可以为临床进一步了解肺动脉高压时左心功能早期受损情况提供参考指标。     

经食管超声心动图在重度肺动脉高压中的应用价值

目的探讨经食管超声心动图(TEE)在重度肺动脉高压病因诊断和鉴别诊断中的应用价值.方法对47例原因不明的重度肺动脉高压患者进行了经胸超声心动图(TTE )和TEE检查.结果 47例肺动脉高压患者中,TEE诊断分流性先天性心脏病17例,其中房间隔缺损9例,主肺动脉间隔缺损1例,在降主动脉短轴切面检出动脉导管未闭7例;左肺动脉和右肺动脉远段附壁血栓形成4例(继发性肺动脉高压组).余26例原因不明(原发性肺动脉高压组).继发性肺动脉高压组和原发性肺动脉高压组比较,TTE测量指标和主要临床资料无显著性差异.结论 TEE技术在不明原因重度肺动脉高压的病因诊断和鉴别诊断中具有重要临床应用价值.     

超声心动图对肺动脉高压的诊断价值

目的评估超声心动图在诊断肺动脉高压中的临床应用价值。方法回顾分析我院收治的257例肺动脉高压患者的临床资料,根据平均肺动脉压将其分为三组,轻度组84例,中度组105例及重度组68例。通过分析三组超声心动图与右心导管检测的肺动脉压力之间的差异及相关性,评估超声心动图检测肺动脉压力的准确性;通过分析不同程度肺动脉变压患者的超声参数,探讨心脏结构、功能及血流动力学在不同程度肺动脉压力下的变化特点。结果 52例患者进行了超声心动图和右心导管检查。超声心动图估测的肺动脉收缩压高于右心导管测值(P0.05);但两种方法测量值相关性良好(r=0.854,P0.01)。重度组较轻、中度组的左室舒张末期前后径显著缩小,右室舒张末左右径显著增宽(P0.05或P0.01);所有患者的三尖瓣反流最高流速从轻、中、重度肺动脉高压显著加快(P0.01)。结论超声心动图是估测肺动脉压简便而有效的方法,可以用于肺动脉高压患者的筛查,并可作为评价肺动脉高压严重程度的参考指标。     

经胸超声心动图在特发性肺动脉高压诊断中的临床价值

目的 应用超声心动图技术研究特发性肺动脉高压(idiopathic pulmonary arterial hypertension,IPAH)患者的心脏结构及血流动力学特点,对比右心导管结果,探讨超声心动图在诊断IPAH中的临床价值.方法 选择经右心导管检查确诊的IPAH患者42例,正常对照组30例.经胸超声心动图测量左、右心室舒张末期前后径及左右径(RVT、LVT),计算左、右心室前后径及左右径的比值(RVD/LVD、RVT/LVT);测量右室前壁厚度(RVAWT)及左室后壁厚度(LVPWT),计算RVAWT/LVPWT;多普勒超声测量三尖瓣及肺动脉瓣最大反流压差等参数,并将右心导管与超声心动图的检测指标进行相关性分析.结果 本研究中女性患者最常见,男女比为1∶2.5.本组IPAH患者,肺动脉收缩压(PASP)与肺动脉平均压(PAMP)均明显增高.RVD/LVD、RVT/LVT、RVAWT/LVPWT各指标,IPAH组与正常对照组之间均有明显统计学意义.超声心动图估测肺动脉收缩压(PASPe)与右心导管检测PASPc呈显著相关,超声心动图估测PAMPe与右心导管检测者相关性良好;RVD/LVD、RVT/LVT、RVAWT/LVPWT指标中,RVAWT/LVPWT、RVT/LVT与PASPc呈明显相关,RVD/LVD与PASPc的相关性无明显统计学意义.结论 超声心动图能够准确反映IPAH患者肺动脉高压的阶段和程度,超声心动图通过准确评价心脏的结构及血流动力学特点可为诊断IPAH提供客观准确的依据.     

超声心动图在肺动脉栓塞诊断中的价值

急性肺动脉栓塞是由于内源性或外源性栓子堵塞肺动脉主干或分支引起的以肺循环障碍为主要表现的临床和病理生理综合征。其临床表现呈多样化且无特异性,漏诊率高达67％～79％,其发病牢仅次于冠心病及高血压病;死亡率居第三位,仅次于肿瘤及心肌梗塞,陶此早期诊治尤为重要。本研究对17例肺栓塞患者的超声心动图表现进行总结和分析。     

新生儿持续性肺动脉高压的超声心动图诊断价值

对我院新生儿持续性肺动脉高压(PPHN)40例患儿的资料进行总结，以探讨超声心动图对该病的诊断价值。     

超声心动图在肺动脉栓塞诊断中的应用价值

肺动脉栓塞（PE）是临床较常见的疾病，其病程凶险，死亡率高，临床表现多样且不具特异性，容易发生漏诊和误诊。随着影像技术的发展，PE的诊断水平显著提高。CTA、MRA等检查费用较大，需用造影剂，存在一定的风险。超声心动图检查具有方便、快捷、创伤小、费用低等优点，在PE的诊断中有着重要的作用。作者回顾性分析了在本科诊断的32例PE患者的临床资料，现报告如下。     

多普勒超声心动图在诊断原发性肺动脉高压的应用

目的探讨多普勒超声心动图对原发性肺动脉高压(PPH)诊断和鉴别诊断的价值.方法回顾性分析75例PPH患者的超声诊断,部分与心导管结果对照.结果 75例PPH患者中,超声诊断67例,诊断符合率达89.3%;其中有18例与心导管检查对比,两者对肺动脉压力的测定结果无明显差异(89.3±23.2) mmHg vs (80.8±25.6) mmHg, P＞0.05,两种方法相关性好(r=0.82, P＜0.001);早期PPH患者左心收缩功能可正常,晚期严重PPH患者则降低.结论超声心动图可无创、准确测定PPH患者肺动脉压力,重复性好;超声心动图在PPH诊断与鉴别诊断方面有一定的价值;超声心动图检测PPH患者左室收缩功能,可了解病情进展和评估疗效.     

The value of speckle-tracking echocardiography in identifying right heart dysfunction in patients with chronic thromboembolic pulmonary hypertension

Right ventricular (RV) function is a significantly important factor in the determination of the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH) patients. Speckle-tracking echocardiography (STE) is an angle-independent new technique for quantifying myocardial deformation that is capable of providing data on multiple parameters including longitudinal and transverse information of the myocardium. In the present study, we aimed to study the advantages of STE-derived parameters in identifying RV dysfunction in CTEPH patients. Sixty CTEPH patients (mean age: 55 years?±?13 years; 25 males) and 30 normal controls (mean age: 54 years?±?14 years; 14 males) were enrolled in this study. RV free wall (RVFW) systolic peak longitudinal strain (LS) including the basal, mid-, and apical-segments and the basal longitudinal and transverse displacement (basal-DL and basal-DT) were measured by STE. Global LS (GLS) of the RV was calculated by averaging the LS value of the 3 segments of RVFW. Clinical data of CTEPH patients were collected. CTEPH patients were divided into 2 subgroups according to the World Health Organization function classification. Clinical right heart failure (RHF) was defined as the presence of symptoms of heart failure and signs of systemic circulation congestion during hospitalization. The apical segment LS of the RVFW was lower than that in the basal and mid-segments in the control group (P?<?0.001), but no significant difference was found among the 3 segments of LS in the CTEPH group (P?=?0.263). When we used the cutoff value recommended by the American Society of Echocardiography guidelines to identify abnormal RV function, 30 CTEPH patients (50%) by tricuspid annular plane systolic excursion (TAPSE), 42 patients (70%) by fractional area change (FAC), 20 patients (33.33%) by RV index of myocardial performance (RVIMP), and 46 patients (77%) patients by GLS were determined to have abnormal RV function, respectively. Among multiple RV function indicators, TAPSE, FAC, GLS, basal-DL, and N-terminal pronatriuretic B-type natriuretic peptide showed significant differences between CTEPH patients with mild (WHO II) and severe symptoms (WHO III/IV) (all P?<?0.001), while RVIMP and basal-DT showed no significant difference (P?=?0.188 and P?=?0.394, respectively). Pearson correlation analysis showed that GLS has no correlation with sPAP as evaluated by echocardiography in CTEPH patients (r = ??0.079, P?=?0.574), and a weak to moderate correlation with RA area (r?=?0.488, P?=?0.000), the RV diameter (r?=?0.429, P?=?0.001), and the RVFW thickness (r?=?0.344, P?=?0.009). On receiver operating characteristic analysis, GLS has the largest area under the curve to identify RHF when the cutoff value was ??13.45%, the sensitivity was 78.2%, and the specificity was 84.6%, separately. Our study demonstrated that the depression of regional LS of RVFW is more pronounced in the basal and middle segments in CTEPH patients. Also, the longitudinal movement is much more important than the transverse movement when evaluating RV systolic function. As compared with conventional parameters, RVFW GLS showed more sensitivity to identify abnormal RV function and had the largest AUC for identifying RHF. Additionally, GLS showed no correlation with sPAP and a weak correlation with right heart morphological parameters in our CTEPH cohort.     

超声心动图对肺动脉高压和肺静脉高压的非侵入性鉴别诊断研究

目的 确定超声心动图是否能非侵入性鉴别诊断肺动脉高压(PAH)和肺静脉高压(PVH).方法 随机选择56例经超声心动图确定的肺动脉收缩压(PASP)≥40 mmHg的患者,并在7 d内进行心导管检查.依据左室舒张末压或肺毛细血管契压(PCWP)将患者分为PAH组30例,PVH组26例.两组患者应用常规和组织多普勒超声技术分别测定跨二尖瓣舒张早期峰值血流速度E峰,晚期A峰,E/A比值,二尖瓣血流减速时间(DT),舒张早期二尖瓣环运动速度(E')和E/E'值.结果 与PVH组比较,PAH组A峰、DT、PASP及E,增大,而E峰、E/A值和E/E'值却降低.E/E'值和E/A值是PAH和PVH鉴别诊断的最佳指标,其E/E'值和E/A值的ROC曲线下面积分别为97%和91%,而诊断PVH的最佳界值点是E/E'>9.2(敏感性为95%,特异性为97%),E/A>1.7(敏感性为75%,特异性为92%).结论 采用常规和组织多普勒超声技术可正确鉴别PAH和PVH.     

超声心动图在肺动脉高压诊治中的应用与展望

<正>肺动脉高压(pulmonary arterial hypertension,PAH)是指静息状态下经右心导管测得的平均肺动脉压(mean pulmonary arterial pressure,m PAP)≥25 mm Hg(1 mm Hg=0.133 k Pa)的一种病理生理状态[1]。PAH可以是一种独立的疾病,也可以是并发症,还可以是综合征[2-3]。随着学界对PAH疾     

早产窒息新生儿同型半胱氨酸联合心肌酶测定的临床价值

目的探讨同型半胱氨酸(Hcy)联合心肌酶谱检测在早产窒息新生儿中的临床价值,为临床鉴别诊断及治疗早产患儿提供科学依据。方法选取2011年1月至2014年5月在该院住院的早产新生儿高胆红素血症患儿150例,并分为轻度窒息组和重度窒息组,同时选取新生儿生理性黄疸患儿100例设为对照组,分别检测血清总胆红素(TBIL)、同型半胱氨酸(Hcy)及心肌酶谱各指标水平,并进行比较分析。结果轻度窒息组及重度窒息组患儿Hcy、TBIL及各项心肌酶谱指标水平均高于对照组,差异均有统计学意义(P0.05)。结合临床资料及彩色多普勒超声检测结果,早产窒息高胆红素血症患儿中有3例诊断为心肌炎,29例诊断为亚临床心肌炎,46例诊断为疑似心肌炎。结论早产高胆红素血症患儿心肌细胞存在不同程度损伤,常规测定Hcy及心肌酶谱对临床诊断新生儿心肌炎及亚临床心肌炎有积极意义。     

Therapy of pulmonary hypertension in neonates and infants

Pulmonary hypertension (PH) in newborns and infants can present in its idiopathic form or complicate a long list of other diseases. Most of these conditions are either pulmonary or cardiovascular in origin. In the present review our currrent knowledge regarding pathophysiology, structural changes, diagnosis, and available treatment options for PH in the age group below 1 year of age is summarized. New treatment options available in adults including endothelin receptor antagonists (ETRA) and phosphodiesterase (PDE) inhibitors are presented and the need for randomized controlled trials in newborns and infants is emphasized. Future candidates for pharmacotherapy of PH in infants include among others vasoactive intestinal polypeptide (VIP), PDE-3 and PDE-4 inhibitors, hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, and adrenomedullin (ADM).     

解剖M型超声心动图观测肺动脉高压患者肺动脉主干前侧壁运动曲线

目的　探讨解剖M型超声心动图在观测肺动脉高压患者的肺动脉主干运动曲线中的作用。方法　 2 1例合并有三尖瓣反流的肺动脉高压患者以及 2 1例年龄和性别与病变组配对的正常人 ,常规超声心动图测定肺动脉干内径、右心房内径、肺动脉瓣血流频谱上升支加速时间 (ACTpv)、三尖瓣反流峰值流速 ,并根据后者推算肺动脉收缩压 (PASP)。采用解剖M型超声后处理系统 ,观测肺动脉干运动曲线并测定肺动脉干前侧壁搏动幅度 (PAWPA)。结果　肺动脉高压组的PAWPA低于正常组 ,同时伴有肺动脉干增宽、右心房内径增大、ACTpv缩短 (均P <0 .0 5)。肺动脉高压组PAWPA与PASP呈中度负相关 (r =-0 .549)、与ACTpv呈中度正相关 (r =0 .40 2 )。结论　解剖M型超声心动图可用于观测PAWPA ,该参数有可能作为一个新的简便易行评估肺动脉高压的定性或半定量指标