右心室流出道多普勒血流频谱和肺毛嵌压对老年肺心病的临床诊断价值

为了评价脉冲多普勒记录右心室流出道（ＲＶＯＴ）及左室流入道（ＬＶＩＴ）血流频谱以检测肺动脉压（ＰＡＰ）和肺毛嵌压（ＰＣＷＰ）对老年肺心病的临床意义。研究老年肺心病（ＣＰ）２１例、老年慢性支气管炎（ＣＢ）２２例、健康老人（Ｈ）１５名。结果和结论：１）在ＲＶＯＴ比在肺动脉主干内记录血流图容易成功，在ＬＶＩＴ测定左室等容舒张时间比心机图容易；２）ＲＶＯＴ血流频谱可将ＣＰ与ＣＢ及Ｈ区别开来（Ｐ＜０．０１）。ＣＰ的ＲＶＯＴ血流图的特点是，加速时间缩短，＜１００ｍｓ；右心室收缩时间间期异常，ＲＰＥＰ／ＲＶＥＴ＞０．４；由血流曲线计算的肺动脉压及即血管总阻力增高；３）有气短和肺湿性罗音，如ＰＣＷＰ不高，则不支持左心功能不全或舒张型心力衰竭；４）ＣＰ患者的血浆心钠素（ＡＮＰ）显著升高。这反映肺动脉压和右心房压力升高；５）本文ＲＶＯＴ血流图诊断ＣＰ的敏感性为９０．５％，特异性９４．６％。

Clinical Diagnostic Values of Doppler Spectrum in Right Ventricular Outflow Tract and Pulmonary Capillary Wedge Pressure for Cor Pulmonale in Elderly

In order to evaluate the Doppler spectrum of right ventricular outflow tract (RVOT) and left ventricular inflow tract (LVIT) there by to estimate pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) for cor pulmonale (CP) in elderly, 21 patients (6>years ) with CP, 22 patients (>60 years) with chronic bronchitis (CB) and 15 healthy (H) subjects (>60 years) were studied. Results and conclusions: 1) The Doppler spectrum was obtained more easily and simply in RVOT than in main pulmonary artery. The isovolumic relaxation time was measured more easily by LVIT Doppler spectrum than by mechanocardiography. 2)RVOT spectrum may differ CP from CB and H (p< 0. 1). The features of RVOT Doppler for CP reveiled: shortened acceleration time(<100ms ), abnormal RPEP/RVET (>0. 4), increased PAP and pulmonary total resistance. 3) Normal PCWP did not support the diagnosis of left heart failure in the presence of dyspnea and rales in lungs. 4 ) Increased atrial natriuretic peptide in plasma, related to increased right atrial pressure resulted from pulmonary hypertension. 5) The sensitivity and specificity of RVOT Doppler for diagnosing CP were 90. 5% and 94. 6% respectively.