婴幼儿喘息疾病急性发作期肺动脉压及右心功能改变临床研究

目的:探讨婴幼儿喘息疾病急性发作期肺动脉压力与右心功能的改变?方法:选择2009年10月至2012年1月收治的婴幼儿喘息性疾病急性发作期病例为研究组(n = 100),其中分重症组(n = 23)和轻症组(n = 77),选择同期健康体检的婴幼儿为对照组(n = 100),超声心动图测定肺动脉压(PAP)?右室射血分数(RVEF)?肺血管阻力(PVR)?右室射血时间(RVET)?肺动脉瓣血流加速时间(AT)以及Tei指数,同时进行血气分析?研究组在常规平喘?吸氧治疗基础上予以降低肺动脉压及强心?利尿及钙离子拮抗剂等治疗?结果:100例研究组中肺动脉高压患者34例(34%),其中重症组23例,轻症组11例,无肺动脉高压患者66例(66%);100例健康对照组中肺动脉高压2例(2%),无肺动脉高压者98例(98%),研究组与对照组比较?重症组与轻症组比较,差异均有统计学意义(P < 0.05)?血气分析显示,肺动脉高压患者动脉氧分压(PaO2)?血氧饱和度明显低于无肺动脉高压患者且差异有统计学意义(P < 0.05);研究组较对照组RVET?AT值减小,PAP?PVR升高,两组比较差异有统计学意义(P < 0.05),重症组较轻症组RVET?AT值减小,PAP?PVR升高,两组比较差异有统计学意义(P < 0.05)?结论:婴幼儿喘息疾病急性发作期有肺动脉高压和右心舒张功能下降,且随着病情进展,变化显著?

Changes of pulmonary artery pressure and right ventricular function in the infants with acute asthma

Objective:To investigate the changes of pulmonary artery pressure(PAP) and right ventricular function in the infants with acute asthma. Methods: One hundred infants during the acute stage of asthmatic disease as observation group(including 23 severe cases and 77 mild cases) and one hundred healthy infants as control group were chosen in this study from October 2009 to January 2012. PAP,right ventricular ejection fraction(RVEF),pulmonary vascular resistance(PVR),right ventricular ejection time(RVET),acceleration time(AT) and Tei were measured as previously reported using echocardiography,and blood gas was analyzed simultaneously. The infants in observation group were conventionally treated with cardiac diuretics and calcium antagonists in order to reduce pulmonary artery pressure and strengthen the heart function. Results: The incidences of pulmonary hypertension was 34%(34/100) in the observation group,23 cases with severe asthma and 11 cases with mild asthma, and 2%(2/100) in the control group. The difference of the incidences of pulmonary hypertension between two groups was significant(P < 0.05),and the incidence of pulmonary hypertension in severe cases was significantly higher than that in mild cases(P < 0.05). PaO2 and SaO2 in the infants with pulmonary hypertension were lower than those who without pulmonary hypertension (P < 0.05). Compared with the control group,RVET and AT decreased,PAP and PVR increased significantly in the observation group (P < 0.05). Compared with mild cases,RVET and AT decreased,PAP and PVR increased significantly in severe cases(P < 0.05). Conclusion: Pulmonary hypertension and declined right ventricular function emerged in the infants with acute stage of asthmatic disease,and aggravated with the disease progress.