超声心动图对新生儿肺动脉高压的诊断价值

目的 探讨超声心动图对新生儿肺动脉高压的诊断价值。方法 收集2011年6月至2014年12月接收的80例新生儿,其中经过超声心动图证实患有新生儿持续肺动脉高压(PPHN)的新生儿38例,根据肺动脉压力分为轻度组(20例)、中度组(12例)、重度组(6例),其余42例新生儿为对照组。通过超声心动图测量比较各组患儿心脏各腔室大小,并对比分析测量结果。结果 患儿心脏右房内径、右室内径及主肺动脉内径随着肺动脉收缩压(PASP)的增高均有增大趋势。对照组与轻度组、轻度组与中度组、中度组与重度组间右心房内径(RA)、右心室内径(RV)、主肺动脉内径(MPA)分别作两组样本t检验,结果差异均有统计学意义(P<0.05);随着PASP的增高,新生儿低氧血症(PO₂)逐渐加重,各组样本间差异有统计学意义(P<0.05)。结论 超声心动图可对新生儿肺动脉高压进行准确诊断,对判定患儿预后、临床诊疗均有重要价值。     

超声心动图法测定肺动脉收缩压的可靠性和存在问题

目的 与有创的导管法对照,评价多普勒超声心动图法测定肺动脉高压患肺动脉收缩压的可靠性和存在的问题。方法 临床诊断为原发性肺动脉高压患７３例,右心导管法实时监测右房、室压及肺动脉压,同时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（△ｐ）,并与心导管法测量结果进行相关性分析。注意分析超声心动图法测定过程中出现的问题并讨论解决方法。结果 多普勒超声心动图法测定的△ｐ与导管法测定结     

超声心动图在肺动脉高压病变中的诊断价值研究

目的:探讨在肺动脉高压病变诊断中应用超声心动图的临床价值.方法:选取疑似肺动脉高压病变者87例为医学观察对象(病变组),入组患者均采取超声心动图及右心导管检查,以后者检查结果为金标准,分析超声心动图在肺动脉高压病变诊断中的准确度、特异度及敏感性.另选取同期来院体检健康人群60例作为健康组,均予以超声心动图检查.将检...     

超声心动图在肺动脉栓塞诊断中的价值

肺动脉栓塞是指体静脉或右心栓子脱落，随血流漂流堵塞肺动脉或其分支所引起肺循环障碍的一种临床综合征，是一种死亡率很高的疾病，以往临床对于此病的正确诊断比较困难，经常发生漏诊和误诊。因此，对于肺动脉栓塞的诊断越来越值得关注，尤其是对影像学的诊断方法更加重视，本研究旨在探讨超声心动图在肺栓塞诊断中的价值。     

超声心动图诊断肺动脉高压的临床探讨

目的探讨超声心动图检查对肺动脉高压诊断的准确性及意义.方法选取2009年3月~2012年4月在天津市海河医院就诊的103例慢性阻塞性肺疾病伴肺动脉高压患者,应用连续多普勒测三尖瓣返流峰速,根据简化的伯努利方程推算肺动脉收缩压.结果(1)103例患者超声心动图均表现为右室、右房增大,肺动脉增宽,三尖瓣高速返流,肺动脉收缩压为34.2~102.2mmHg;(2)肺动脉血流频谱呈“匕首”样改变,收缩期加速时间缩短,峰值提前;(3)肺动脉瓣M型超声显示肺动脉瓣开放曲线呈“W”形.结论超声估测肺动脉压简单、无创、可重复性好,对肺动脉高压的定性及定量诊断有重要意义.     

超声心动图诊断肺动脉高压157例分析

目的: 探讨超声心动图诊断肺动脉高压(pulmonary hypertension,PH)的临床价值。方法: 对157例经超声心动图检查诊断的PH患者再行CT、X线、肺动脉造影等检查明确诊断,并将超声心动图估测肺动脉压与右心导管测量肺动脉压作比较。结果: 157例经临床确诊PH156例,误诊1例;结合临床超声心动图检查明确PH病因149例;行心导管检查14例,导管所测肺动脉压与超声心动图所测肺动脉压基本一致。结论: 超声心动图诊断PH具有无创,准确率高,快捷,以及可重复性强等优点,而且可以明确大部分患者的病因,但要求检查医生具有丰富的经验。     

超声心动图诊断老年冠心病患者肺动脉高压的临床价值

目的 探讨超声心动图对老年冠心病患者肺动脉高压诊断的效果及安全性.方法 超声心动图检测80例冠心病患者,并按照肺动脉收缩压（PASP）分为无肺动脉高压组（A组）、轻度肺动脉高压组（B组）、中度肺动脉高压组（C组）和重度肺动脉高压组（D组）.结果 B、C、D组患者RVAW明显高于A组,RVAW/LVPW比值均明显高于A组,B、C两组RVAW/LVPW值明显低于D组,差异有统计学意义（P〈0.05）.结论 RVAW/LVPW对检测和判定患者肺动脉压力存在与否以及是否存在高危险性具有积极作用,但最好结合其它判定肺动脉高压的标准,以提高临床诊断的准确性.     

超声心动图监测肺动脉高压20例

<正> 作者利用超声心动图检测了20例肺心病患者服用硝苯吡啶后肺动脉压力的变化,现分析总结如下。 1资料与方法 1.1临床资料;20例患者为我院1991—1994年住院患者,男15例,女5例;年龄47—73岁(54.5±3.2),均符合1980年全国慢性肺心病诊断标准,并排除冠心病及其它器质性心脏病。     

超声心动图对新生儿肺动脉高压的诊断价值及疗效评价

目的探讨超声心动图对新生儿肺动脉高压的诊断、分类及评估临床疗效的价值。方法回顾分析经超声心动图证实存在肺动脉高压,并无右室流出道梗阻及肺动脉狭窄的33例新生儿超声心动图及临床资料,并根据所测肺动脉收缩压力的高低将患儿分为轻、中、重三组。根据导致肺动脉高压的原因分为心源性、肺源性,其中肺源性又分为一过性肺动脉高压和持续性肺动脉高压。比较各组患儿之间心脏右心各腔室大小、导致肺动脉高压的原因以及治疗后肺动脉压力的变化。结果随着肺动脉压力的增高,患儿心脏右心各腔室有增大的趋势。超声心动图所测肺动脉压力变化与患儿临床转归表现一致。结论超声心动图是新生儿肺动脉高压最重要的无创检查方法之一,它不仅有助于该疾病确诊、分类,而且对临床判断病情轻重、选择治疗时机、评估疗效及预后都有重要价值。     

超声心动图对老年肺动脉高压患者右心功能的评价

目的 探讨超声心动图对老年肺动脉高压患者右心功能评价的临床效果. 方法选取临床确诊的老年肺动脉高压患者30例为观察组,另选30例健康成年人作为对照组.超声心动图检查两组右心室前后径、右心房横径和肺动脉主干内径,并计算右心室Tei指数.比较分析两组检查结果. 结果观察组患者的右心室前后径、右心房横径、肺动脉主干内径和正常对照组相比,显著增大,差异有统计学意义（P〈0.05）;观察组患者Sm、Em和Am显著低于对照组（P＜0.05）,右心室Tei指数和对照组相比,显著增大,差异有统计学意义（P＜0.05）. 结论超声心动图评价老年肺动脉高压患者右心功能具有较高临床价值.     

Novel parameter for assessment of left atrial size in patients with hypertension: ratio of left atrial volume to left ventricular volume

Background Left atrial enlargement has been suggested as a more robust marker of diastolic dysfunction. We hypothesize that the ratio of left atrial volume to left ventricular volume （LAV/LVV） may be more reasonable to reflect left atrial enlargement in the patients with hypertension, because hypertensive patients have a characteristic of concentric remodeling of the left ventricle which is often accompanied with diastolic dysfunction. The aim of this study was to determine if the LAV/LVV can be used as a new parameter to assess left atrial size in hypertensive patients and the relationship between the LAV/LVV and diastolic dysfunction. Methods Ninety-one patients with hypertension and forty-three normal controls were studied. The hypertensive patients were assigned to the normal wall （NW） and hypertrophic wall （HW） groups. The left atrial diameter （LAD）, LAV, left atrial volume index （LAVi）, LVV and LAV/LVV were measured and calculated by 2-dimensional echocardiography and real time 3-dimensional echocardiography. All of the above parameters were used to evaluate the size of the left atrium. The ratio of peak E velocity of mitral valve inflow to peak E＇ velocity of lateral mitral annulus （E/E＇） was measured by pulse Doppler and tissue Doppler. This parameter was used to evaluate diastolic function. Results The LAD, LAV, LAVi, LAV/LVV and E/E＇ in hypertensive groups were significantly higher than those in the normal group （P 〈0.05 or 0.01）, and those in the HW group were significantly higher than those in the NW group （P 〈0.05 or 0.01）. The E/E＇ had a positive correlation with LAV, LAVi and LAV/LVV. The correlation coefficient between E/E＇ and LAV/LVV was relatively higher than that between E/E＇ and LAD or LAVi. Conclusion LAV/LVV may be used as a new index to evaluate left atrial size in hypertensive patients with diastolic dysfunction.     

Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in idiopathic pulmonary arterial hypertension

Background  An echocardiographic right/left ventricular end-diastolic diameter ratio (RV/LV ratio) ≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dilation is a common characteristic of both acute pulmonary embolism and idiopathic pulmonary arterial hypertension (IPAH). However, the prognostic value of the RV/LV ratio in patients with IPAH is unknown.

Methods  Ninety-five consecutive patients with newly diagnosed IPAH were included, 17 were re-evaluated by echocardiography after 3–12 months of targeted therapy. Follow-up data were obtained by telephone interviews and review of the patients’ records.

Results  Higher RV/LV ratios were associated with greater functional impairment. The RV/LV ratio was positively correlated with pulmonary vascular resistance (r=0.549, P <0.001) and plasma N-terminal pro-brain natriuretic peptide level (r=0.575, P <0.001), but negatively correlated with cardiac output (r= –0.517, P <0.001) and mixed venous oxygen saturation (r= –0.599, P <0.001). Twenty-seven patients died during follow-up period. Sensitivity and specificity of an RV/LV ratio ≥0.84 for predicting death were 85.2% and 51.5%, respectively. The RV/LV ratio and body mass index were independent predictors of death by multivariate Cox analysis (P <0.01). A baseline RV/LV ratio ≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis (P <0.01).  

Conclusion  The RV/LV ratio helps to assess the severity of IPAH and may serve as an independent predictor of prognosis in patients with IPAH.

     

右心室压力及容量超荷患者左心室几何形态的不同

目的： 探讨右心室压力及容量超荷患者左心室几何形态的不同。方法： 应用二维超声心动图观察２８例右心室容量超荷（ ＲＶＶＯ） 和２４ 例右心室压力超荷（ ＲＶＰＯ） 患者的室间隔、左心室几何形态及左心室偏心指数（ＬＶＥＩ） ,并与４０ 例正常人对比分析。结果： ＲＶＶＯ 患者仅见舒张末室间隔变平、左移或凸向左室腔,左室腔几何形态由正常的圆形变为椭圆形或不规则形、ＬＶＥＩ 较正常组明显增大（ Ｐ＜ ０ ．０００５） ,收缩末上述改变恢复正常;而ＲＶＰＯ 患者收缩末及舒张末左心室腔几何形态、ＬＶＥＩ 均为异常。结论： ＲＶＶＯ 及ＲＶＰＯ 患者左心室几何形态的改变存在明显不同,应用ＬＶＥＩ 可对其进行定量判断     

24h动态血压超声心动图对高血压左室肥厚的研究

目的探讨高血压对左室肥厚影响的关系。方法利用血压自动记录仪分析301例高血压患者24h动态血压波动昼表节律变异规律。结果24h动态血压监测，其中勺型高血压47例，占15，6％；非勺型高血压254例。占84．4％。114例左室肥厚患者中勺型高血压21例，占18．4％，非勺型高血压87例，占81．6％。经统计学处理，两者差异具有显著性P〈0．01。结论高血压左室肥厚患者发生猝死、心肌梗死、心律失常和心衰的几率较无左室肥厚者明显增高，故对高血压左室肥厚者早发现，早治疗减少以上危险因素有积极作用。     

Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes: an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE). Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE. On RT3DE “full volume” imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software. On 2DE imaging, the volumes were measured by the Simpson method. The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data.Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values (r=0.795-0.998) and there was a good correlation between 2DE estimates and reference values (r=0.715-0.729). There were no significant differences between RT3DE estimates, 2DE results and reference values (P&gt;0.05). In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values (r=0.765-0.988), but 2DE weakly correlated with reference values (r=0.518-0.592). There were no differences between RT3DE and reference values (P&gt;0.05), but a significant difference between 2DE and reference values occurred (P&lt;0.05). For excised canine hearts, there was a strong correlation between RT3DE and reference values (r=0.728-0.914), while 2DE showed a less obvious correlation (r=0.502-0.615). Again, there were no significant differences between RT3DE and reference values (P&gt;0.05), but there was a significant difference between 2DE and reference values (P&lt;0.05).Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function. For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience.     

Evaluation of Right Ventricular Volume and Systolic Function by Realtime Three-dimensional Echocardiography

Increasing evidence from clinical investigationis emphasizing the importance of evaluating rightventricular (RV) function[1—4]. Whereas, becauseof the complex shape, evaluation of RV functionby conventional 2 D echocardiography has beenconsidered difficult. The development of real timethree dimensional echocardiography ( RT3DE )opens up the possibility of assessing RV function.This high speed, volumetric ultrasound scanningsystem could display the cardiac spat…     

高血压患者左室功能状态的研究

比较高血压患者与正常对照左室收缩功能和舒张功能各指标之间的差异。方法：用超声心动图的方法测量左室收缩功能及舒张功能指标。结果：高血压患者较早期即已有左室重量数增大，室间隔舒张末期厚度（ＩＶＳｄ）、左室后壁厚度（ＰＷＴ）、相对室壁厚度（ＲＷＴ）的增加，且与下沉组比较有显著性差异（Ｐ〈０．０１）。说明左室的几何形状及重量发生改变，即产生了左室重构。ＬＶＭＩ与左室舒张功能各指标相关性好（Ｐ〈０．０５或〉     

实时三维超声心动图评价不同肺动脉高压房间隔缺损患者右室形态及功能

目的 探讨实时三维超声心动图在评价不同程度肺动脉高压的房间隔缺损患者右心室形态及功能改变中的准确性及可行性.方法 选取60例单纯继发孔型房间隔缺损患者作为病例组,根据三尖瓣反流峰速估测的肺动脉收缩压将病例组分为轻、中、重度3组,选取34例健康体检者作为正常对照组,利用实时三维超声心动图分别测量4组研究对象的右室舒张末容积、右室收缩末容积、每搏量及射血分数,并将所测各组右心室参数进行统计分析.结果 重度组较之轻、中度组及正常对照组,右室舒张末容积、右室收缩末容积明显增大,右室射血分数明显减小（P＜0.05）;中度组较之轻度组及正常对照组,右室舒张末容积、右室射血分数增大（P＜0.05）;轻度组右室舒张末容积、右室收缩末容积、右室每搏量及右室射血分数较之正常对照组均无明显差异.结论 实时三维超声心动图技术可无创、准确地评价不同程度的肺动脉高压对房间隔缺损患者右室形态及功能的影响,为临床诊疗提供可靠依据.     

Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

Background Pulmonary hypertension （PH） is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle （LV）？ The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging （Wl） technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups：mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity （Tvl）,the peak systolic longitudinal velocity （Vsl）,the peak diastolic longitudinal velocity （Vel）,the peak systolic longitudinal strain （SI）,and strain rate （SRI） in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference （P ＞0.05）.With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant （P ＜0.01）,and the differences between other groups were statistically significant （P ＜0.01）.In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant （P ＜0.01）.Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable.     

多普勒超声心动图测定高血压病左室主动舒张功能和左房收缩功能

用脉冲多普勒超声心动图测定舒张早期和舒张晚期经过二尖瓣口的血流速度峰值，结合二维超声测定二尖瓣环直径推算的二尖瓣口面积，根据牛顿第二运动定律加速度和质量的概念测定了４０例正常人和３５例高血压病患者的左室主动舒张力（Ｆ１）和左房射血力（Ｆ２）。结果显示：高血压病组的Ｆ１测值明显低于正常对照组（Ｐ＜０．０１）而Ｆ２的测值则明显高于正常对照组（Ｐ＜０．００１）。提示：高血压病患者的左室主动舒张功能下降，而左房产生代偿性收缩功能增强，作功增多，以维持正常的左室泵功能。