中大型室间隔缺损肺动脉高压时滞特征及肺动脉顺应性的超声评价

目的:分析中大型室间隔缺损患者的肺动脉高压与年龄的相关关系,并探讨肺动脉顺应性指数(pulmonary arterial compliance index,PACI)评价严重阻塞性肺血管病变的潜在价值。方法:应用多普勒超声心动图对349例中大型室间隔缺损患者进行检查,分别测量室间隔缺损直径和跨缺损分流压差,公式计算室间隔缺损面积指数、肺动脉收缩压和肺动脉顺应性指数。结果:年龄与肺动脉收缩压的偏相关系数为0.11(P<0.001)。室间隔缺损面积指数与肺动脉收缩压的偏相关系数为0.49(P<0.001)。肺动脉顺应性指数与年龄的相关关系无统计学意义(r=0.04,P>0.05)。≥15岁组的肺动脉顺应性指数低于其他年龄组(χ2=8.432,P<0.05)。手术禁忌证组和术后恢复较差组的肺动脉顺应性指数均明显低于术后恢复较佳组,手术禁忌证组肺动脉顺应性指数最低(χ2=83.390,P<0.001)。结论:在中大型室间隔缺损患者,肺动脉压、肺动脉顺应性与年龄的相关关系均不密切。肺动脉顺应性指数可作为评价中大型室间隔缺损患者发生高压性肺血管病变的参数,且不同个体差异很大。     

经食管超声心动图测定冠状窦血流对冠状动脉血流储备的评估

目的 :采用经食管超声心动图检查 ,以冠状窦血流测值评估冠心病患者的冠状动脉血流储备 ( CFR) ,探讨其可行性及对冠心病的诊断价值。方法 :先后对 15例冠心病患者及 10例正常人 ,在静脉注射潘生丁前后分别记录其冠状窦血流频谱 ,并测定最大前向血流速度 ( Va- max)、最大逆向血流速度 ( Vr- max)、前向流速时间积分 ( VTIa)及逆向流速时间积分 ( VTIr) ,并以净前向流速时间积分 ( VTIa- VTIr)× HR代表冠状窦实际前向血流 ( CSF) ,再分别以注射潘生丁前后的 Va- max及 CSF比值作为 CFR值。结果 :所有受检者均获得满意的冠状窦血流频谱 ,不论以何种方法计算CFR值 ,所得结果在冠心病者与正常人之间均有极显著性差异 ( P <0 .0 1) ,且以注药前后 CSF比值评估 CFR,对冠心病诊断具有较高的准确性。结论 :经食管超声心动图测定冠状窦血流评估 CFR具有很好的可行性及较高的诊断价值。     

多普勒超声心动图估测肺动脉高压患者血流动力学参数的价值

目的 通过对肺动脉高压（PAH）患者多普勒超声心动图（DE）及右心导管术（RHC）血流动力学参数测值的比较,评价DE估测PAH血流动力学参数的临床价值.方法 选择2009年1月至2012年12月四川省医学科学院·四川省人民医院门急诊及住院部通过DE筛查符合PAH诊断的103例患者进行前瞻性研究,同步比较不同病因及不同肺动脉压力分级的患者RHC与DE血流动力学参数,以了解两种方法 测值的相关性.结果 DE和RHC两种方法 对PAH患者血流动力学测值右心房平均压（mRAP）、平均肺动脉压（mPAP）和肺动脉收缩压（PASP）的总体相关系数分别为0.741,0.698和0.727（P ＜0.05）.其中,以上三项参数在肺动脉压力水平中度升高的患者中呈高度相关（r=0.848,0.775,0.813,P＜0.05）,在肺动脉压力水平重度升高的患者中呈中度相关（r=0.698,0.709,0.712,P＜0.05）,在肺动脉压力水平轻度升高的患者中呈低度相关（r=0.523,0.473,0.480,P＜0.05）.DE诊断PAH的假阳性率为14.56％.而DE诊断结缔组织疾病相关PAH的假阳性率为33.33％.不同病因中,除慢性阻塞性肺疾病外,DE和RHC两种方法 在同一疾病组内检测到的不同级别肺动脉压力患者的数量并无统计学差异（P＞0.05）.结论 DE与RHC血流动力学测值存在显著相关,但在不同病因及不同肺动脉压力分级的患者中有差别.DE在诊断结缔组织疾病相关PAH的假阳性率可能较其他病因高.DE对慢性阻塞性肺疾病相关性PAH患者的肺动脉压力程度的评估价值可能低于其他类型PAH.     

VFM评价正常成人左室心腔血流流场运动状态的初步研究

目的:运用VFM( Vector Flow Mapping)成像探讨正常成人左心室腔内收缩期血流流场特征.方法:健康成人志愿者40例(男22例,女18例),二维超声取心尖三腔观左室腔彩色血流信息动态图像存贮并脱机分析,将取样线分别置于左室腔基底段、中尖段和心尖段,获取心动周期内经取样线部位左室腔血流时间速度积分(Time-Flow curve, TF)变化曲线,记录基底段、中间段及心尖段收缩早期速度时间积分(ES-TF)、收缩中期速度时间积分(MS-TF)、收缩晚期速度时间积分(LS-TF).观察收缩期血流流场特征,观察涡流出现时间,测量涡流直径(横径Dx,)及涡流的最大向量速度(Vmax).结果:正常人左室心腔血流流场呈规则变化,收缩早期二尖瓣前叶下方可见涡流显示,收缩中期及晚期涡流消失.收缩早、中、晚期,血流时间速度积分测值由心尖段经中间段至基底段逐渐递增,差异均有统计学意义(P<0.05).收缩早期涡流直径约为(25.74±7.32)mm, 涡流最大向量速度均背离探头,大小为(38.31±14.25)cm/s,朝向探头速度大小为(11.42±6.28) cm/s.结论:应用VFM技术可清晰显示左室心腔内血流流场状态,左室腔血流速度积分测值可直观反应心腔内血流动力学变化.     

缩窄性心包炎患者的肺静脉血流特征及其诊断价值

目的 :利用双平面或多平面经食管超声了解缩窄性心包炎 (CP)患者的肺静脉血流 (PVF)特征及其辅助诊断的价值。方法 :对 2 4例经超声或临床诊断为CP而接受心脏手术治疗的患者和 15例正常人的PVF特征进行分析。结果 :①CP患者平静呼气末的PVF较正常显著减少 (P <0 .0 5或 <0 .0 1) ;与之相比 ,吸气时患者肺静脉前向性血流进一步显著减少 ,且以收缩期为著 (P <0 .0 1) ,而心房收缩期血流改变不显著。非CP患者的PVF较正常减少 (P <0 .0 5 ) ,但吸气时无显著改变。②依据M型及二维超声诊断CP的敏感性、特异性分别为76 .5 %、87.5 % ,而结合吸气时收缩分数减少 >2 0 %或收缩期峰值血流速度减少 >30 %和舒张期峰值血流速度减少 >2 0 %诊断CP的敏感性、特异性分别为 94 .1%、10 0 %。结论 :CP患者的PVF表现及吸气时的改变有一定的特异性 ,正确认识有助于CP的诊断     

急性肺动脉栓塞误诊为急性心肌梗塞八例原因分析

目的 :分析急性肺动脉栓塞 (APE)误诊为急性心肌梗塞 (AMI)的因素 ,以期提高 APE早期识别。　　方法 :对我院 8例以“AMI”入院 ,最终经同位素肺通气 /灌注扫描或心电图与超声心动图同时确诊为 APE患者的临床资料进行了回顾性分析 ,总结误诊原因。　　结果 :本组 8例患者中 ,7例经同位素肺通气 /灌注扫描证实 APE,1例呈典型的 APE临床、心电图、超声心动图改变而诊断为 APE。入院时 8例均误诊为 AMI。分析又发现 8例患者也均有 APE较为特征性的临床表现 (如呼吸困难、窦性心动过速、P2 亢进 )、动脉血气显示低氧、低碳酸血症和高 p H值 (碱血症 )、心电图特征性改变 [即新出现的 S (>1.5m V)伴 Q 、T (5例 )和心电轴右偏 ]以及心肌酶呈非 AMI典型性衍变 ,而提示 APE。超声多普勒心动图所检 7例中 6例有右心房、室的扩大 (右心室舒张末内径 :平均 36± 2 .6 mm )和肺动脉高压 (平均 5 8.5 8± 12 .84mm Hg,1mm Hg=0 .133k Pa) ,而无 AMI特征性室壁节段运动异常 ,高度支持 APE的诊断。　　结论 :1由于 APE非特异性的临床表现 (如胸闷、胸痛、心悸和出汗 ) ,伴心电图的 T波深倒置 (或 ST- T改变 )以及心肌酶升高的误导 ,同时又忽略了其较相对特征性的临床表现 (如呼吸困难、窦性心动过速和 P2 亢进等 )和心     

老年高血压患者的血压控制现状及影响因素分析

目的分析老年高血压患者的血压控制现状及影响因素,指导老年高血压患者的综合防治。方法回顾性分析老年高血压患者2593例,依据血压控制情况分为血压控制正常组(853例)和高血压组(1740例)。所有患者均进行了超声心动图检查,测定左心室二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)比值(E/A)及LVEF等指标。结果2 593例老年高血压患者服药率和血压控制率分别为94.4%、32.9%。6种常用的降压药物中应用较多的是利尿剂、钙离子拮抗剂、血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂。1988例(76.7%)合并有吸烟史、血脂异常、高血压家族史、肥胖等危险因素。超声心动图检查心脏收缩功能异常率17.2%、E/A比值异常率27.6%。单因素及多因素logistic回归分析,血压控制正常组和高血压组动脉粥样硬化、冠心病、体重指数、TC、HDL-C和左心室后壁等6项指标差异有统计学意义。结论老年高血压患者血压的控制并未有随着服药数量的增加而改善。应该对合并的危险因素及临床情况、生化指标及心脏的结构和功能异常等进行综合防治。     

不同多普勒取样容积对血流速度测量的影响

为探讨脉冲波多普勒不同取样容积（ＳＶ）对最大血流速度（Ｖｍａｘ）测量的影响，我们用内径５．０ｍｍ模拟血管和肝素化人全血，分别以不同血泵流率和ＳＶ为１．５ｍｍ，５．０ｍｍ及１０．０ｍｍ，在仪器其它条件不变的情况下，进行体外模拟脉动血流速度频谱实验。当流率为２００ｍｌ／ｍｉｎ至５００ｍｌ／ｍｉｎ时，ＳＶ为１．５ｍｍ与ＳＶ为５．０ｍｍ和１０．０ｍｍ所测多普勒频谱的Ｖｍａｘ值间差异显著（Ｐ＜０．０１），而ＳＶ为５．０ｍｍ与ＳＶ为１０．０ｍｍｒ测值间差异不显著（Ｐ＞０．０５）。提示在临床工作中，根据所测血管内径，尽可能增大ＳＶ长度，以减少通过时间效应所致频谱增宽，更能准确获得血流速度信息。     

超声心动图新技术评估肺动脉高压右心室重构的研究进展

肺动脉高压(pulmonary hypertension,PH)是一种累及肺部脉管系统和心脏的慢性进行性病理生理综合征,定义为:静息时右心导管测得平均肺动脉压(mean pulmonary arterial pressure,PAPm)≥25 mmHg(1mmHg=0.133 kPa)[1].患者初始常以非特异性呼吸困...     

心脏超声估测肺动脉压对于评估肺栓塞预后的作用

目的 探讨多普勒超声估测肺动脉压力对于评估肺栓塞预后的作用.方法 对66例肺动脉栓塞住院患者进行回顾性分析.根据2008年欧洲心脏病协会颁布的急性肺栓塞诊治指南对肺栓塞患者进行危险分层,根据心脏多普勒超声检查,对于存在三尖瓣反流的患者估测肺动脉收缩压,＞40 mm Hg为肺动脉高压组,≤40 mm Hg为肺动脉压正常组.比较两组间临床指标和危险分层的差异.结果 肺动脉收缩压与肺栓塞患者的危险度分层关系密切(P＜0.05),肺动脉高压组的氨基端前脑钠肽值较肺动脉压正常组明显增高(P＜0.01),但其肌钙蛋白T值与肺动脉压正常组相比差异无统计学意义(P＞0.05).结论 多普勒超声估测肺动脉压力对于肺栓塞预后有一定的评估意义.     

痔动脉结扎肛垫悬吊外剥术与Milligan-Morgan术对痔上动脉分支及血流速度影响的临床研究

目的通过不同手术方式对混合痔患者手术前后痔上动脉分支数量、分布及平均血流速度的观察,了解超声介入痔血管学研究的价值。 方法80例Ⅲ~Ⅳ期混合痔患者随机分为两组,实验组采用痔动脉结扎肛垫悬吊术,对照组采用内扎外剥手术（Milligan-Morgan术）。运用肛周高频彩色多普勒检测各病例术前、愈合时痔上动脉分支数量、部位及平均血流速度变化情况,了解疗效与痔核血供变化是否存在关联。 结果实验组与对照组痔动脉分支数量术前与愈合时比较,差异均有统计学意义（Z=-10.042,-7.488;P<0.05）。两组患者愈合时痔动脉分支数量差异存在统计学意义（Z=-3.500,P<0.05）。实验组术前与愈合时比较,血流速度差异存在统计学意义（t=4.086,P<0.05）,且术前血流速度明显高于愈合时,而对照组的术前、愈合时血流速度比较差异无统计学意义（t=1.385,P>0.05）。两组病例术前痔动脉分布点位均以3、7、11点为主,愈合时,实验组病例痔动脉分布点位以3、5、7、9点为主,对照组病例痔动脉分布点位仍以3、7、11点为主,两组治愈率均为100%;实验组愈合时间优于对照组（t=-3.246,P<0.05）。 结论超声引导下的痔动脉结扎肛垫悬吊术确实能精准结扎痔动脉,改变了痔动脉分支数量及血流速度,对出血痔有显著疗效,且具有愈合时间短的潜在优势。     

Axial development of velocity fields in the porcine main pulmonary artery system

Summary The aim of this study was to provide detailed data on velocity profile development in the normal porcine main pulmonary artery and its main branches. Under spontaneous hemodynamic conditions in twelve open-chest 90kg pigs, perivascular pulsed Doppler ultrasound was used for blood velocity measurements in the entire cross-sectional area in three axial locations in the main pulmonary artery and along one diameter in the main branches. Computerized threedimensional visualizations of the spatial and temporal development of velocity profiles were made throughout the heart cycle. The results were similar one and two diameters downstream of the pulmonary valve. In the early systolic acceleration phase, the velocity profile became skewed, with the highest velocities (132.7 ± 19.4cm · sec^–1) towards the inferior to right superior vessel wall, and rotated counterclockwise 45°–90° during the late acceleration to early deceleration phase in 9 out of 11 pigs. Maximum retrograde velocities (31.4 ± 14.9cm · sec^–1) were observed at the inferior to the right superior vessel wall in the late systolic deceleration phase and in early diastole. During diastole, low retrograde to insignificant antegrade velocities were observed. Immediately upstream of the pulmonary bifurcation, the velocity profile disclosed two peaks at locations corresponding to the two main branches. A confined area with retrograde velocities was seen at the right vessel wall in late systole. Low-scale antegrade velocities were observed throughout diastole in the entire cross-sectional area. In the left main branch, the velocity profiles were found to be somewhat skewed towards the left vessel wall, corresponding to the smaller curvature of the left main branch, while the velocity profile in the right main branch was skewed against the superior vessel wall throughout systole. This study thus disclosed that the blood velocity profiles in the main pulmonary artery system were skewed and that mean velocity varied 26%–50% between measuring points, exhibiting an as yet unexplained rotational phenomenon. The skewed velocity profile in the porcine pulmonary trunk indicates that single-point blood velocity measurements can only serve as a basis for cardiac output estimations when used with considerable caution.This work was supported by grants from the Danish Heart Foundation, the Danish Medical Research Council, the Thomas B. Thriges Foundation, and the Grosserer L.F. Foghts Foundation.     

Acquired pulmonary artery branch stenosis caused by pulmonary thromboembolism.

We present a case of acquired pulmonary artery branch stenosis caused by pulmonary thromboembolism. The patient presented with symptoms mimicking aortic dissection. An emergent transesophageal echocardiogram showed a high gradient across the right pulmonary artery along with mobile thrombi. The vital importance making an accurate diagnosis and ruling out aortic dissection is emphasized in view of the need for urgent heparinization or thrombolysis for pulmonary thromboembolism as this is contraindicated in aortic dissection.     

冠脉造影血流TIMI分级及计帧值与多普勒血流速度的相关性

目的：应用血管内多普勒导丝测量血流速度（DFV）评价冠脉造影血流TIMI分级（TIMI－FG）及其计帧值（TIMI－FC）的准确性。方法：在11只猪的冠状狭窄模型和36例冠脉造影及17例行血管介入治疗的病人，比较TIMI－FG，TIMI－FC与DFV的相关性。结果：（1）随着动物模型充盈球囊造成血管狭窄程度的加重，DFV减慢，TIMI－FG下降，TIMI－FG变大，P均＜0．01；（2）17例病人25支血管在介入治疗后，DFV增加，TIMI－FG上升，TIMI－FC变小（P＜0．05－＜0．01）；（3）TIMI－FC与DFV呈负相关（冠心病人r=-0.49-0.58,猪r=-0.41)；而TIMI－FC变化差值与DFV变化差值相关性则有提高（冠心病人r=-0.62-0.66,猪r=-0.71)。结论：冠脉造影TIMI－FC推测冠心病流速度具有一定准确性，对血流速度变化的推测更佳。     

PTCA前后应用多普勒导丝测定冠状动脉血流速度及储备功能的意义

目的:评价经皮腔内冠状动脉成形术(PTCA)前后应用多普勒导丝测定冠状动脉血流速度及冠状动脉血流储备的变化意义.方法:对25例冠心病患者的31支冠状动脉行PTCA.于PTCA前后用多普勒导丝分别记录狭窄近端和远端的平均峰值血流速度(APV),狭窄近、远端血流速度比(P/DVR)及冠状动脉血流速度储备(CFR).结果:PTCA前31支冠状动脉的直径狭窄率为(84.88±12.25)%.PTCA后残余狭窄为27.65%(P＜0.05),术后病变冠状动脉近端APV较PTCA前有所增加,但差别未达统计学意义[(23.74±15.98)cm/s∶(27.36±18.32cm/s,P=0.06].狭窄远端基础APV、充血相APV及CFR均较术前明显增加[(15.07±11.63)cm/s∶(23.09±10.33)cm/s,(20.53±10.69)cm/s∶(41.67±17.43)cm/s,1.20±0.40∶1.81±0.66,均P＜0.05],P/DVR则明显降低(1.84±1.06∶1.45±0.74,P＜0.05).但残余狭窄的多少与PTCA后基础及充血相APV、CFR、P/DVR改善的程度之间并无明显的相关关系.结论:多普勒导丝测量技术可以更细致的评价PTCA前后冠状动脉血流模式的变化及PTCA术后的急性期疗效,是一种值得在临床上使用并进一步深入研究的新方法.     

Sodium hydrosulfide alleviates pulmonary artery collagen remodeling in rats with high pulmonary blood flow

This study aimed to explore the effect of sodium hydrosulfide (NaHS) on pulmonary artery collagen remodeling in rats with high pulmonary blood flow. Thirty-two Sprague-Dawley rats were randomly divided into a sham group, shunt group, sham + NaHS (an H₂S donor) group, and shunt + NaHS group. After 11 weeks of shunting, mean pulmonary artery pressure (MPAP), relative median area (RMA) of pulmonary arteries, H₂S concentration in lung tissues, plasma endothelin-1 (ET-1) levels, and ET-1 mRNA in lung tissues were investigated. Collagen I and collagen III were evaluated by immunohistochemistry. Hydroxyproline assay and Sirius-red staining were performed. Matrix metalloproteinase-13 (MMP-13), tissue inhibitor of metalloproteinase-1 (TIMP-1), and connective tissue growth factor (CTGF) were evaluated by immunohistochemistry. After 11 weeks of shunting, rats showed a significant pulmonary hypertension and pulmonary artery collagen remodeling in association with a decrease in lung tissue H₂S content. After NaHS treatment for 11 weeks, lung tissue H₂S content was increased, whereas MPAP was attenuated and RMA was reduced. Meanwhile, pulmonary artery collagen I and collagen III protein expressions of intra-acinar pulmonary arteries were inhibited, but MMP-13/TIMP-1 ratio was augmented with a decreased plasma ET-1 content and lung tissue ET-1mRNA and CTGF expressions. The downregulation of H₂S is involved in the development of pulmonary artery collagen remodeling induced by high pulmonary blood flow.     

Unilateral pulmonary artery branch stenosis: Diastolic prolongation of forward flow appears to maintain flow to the affected lung if the pulmonary valve is competent

Background

We sought to improve understanding of the diastolic prolongation of forward flow seen through a unilateral branch pulmonary artery (PA) stenosis.

Methods and Results

Of patients studied by cardiovascular magnetic resonance (CMR) for congenital heart disease, we reviewed right and left PA flow to find 10 cases with a diastolic prolongation of flow in a stenosed branch PA. They were aged 20 years (median, range = 14–40 years, 7 males). Seven had transposition of the great arteries corrected by arterial switch (TGA-AS) and 3 had repaired tetralogy of Fallot (rToF). All had at least moderate unilateral stenosis and competent pulmonary valves. For comparison, we identified 10 patients with unilateral stenosis and at least moderate pulmonary regurgitation, 9 rTOF and 1 TGA-AS, aged 23.5 years (range = 14–42 years, 6 males). Flow in each PA was measured, and in 10 healthy volunteers aged 27 years (range = 20–42 years, 5 males). The curves of flow through stenosed and non-stenosed arteries were averaged for each patient group and compared with those from controls. In competent pulmonary valve patients, the minimum diameters of the stenosed versus non-stenosed branches were as follows (median [range]): 4 [3–8] mm versus 13.5 [10–28] mm, p < 0.001, although their flows differed a little: 2.5 [1.5–6.8] L/min versus 3.2 [1.2–8.8] L/min, p = 0.6. No diastolic tail was identifiable in the patients with unilateral PA stenosis and pulmonary regurgitation, where stenosed versus non-stenosed diameters were 7 [4–12] mm versus 20.5 [13–33] mm, p < 0.001, and flows differed: 1.3 [0.4–2.9] L/min versus 3.8 [3.0–5.0] L/min, p < 0.001. No controls showed stenosis or diastolic tail.

Conclusions

Beyond a competent pulmonary valve, flow through a unilateral PA stenosis, although limited in systole, can continue into diastole, maintaining flow to the lung.