超声评估心力衰竭患者胃肠壁淤血程度的应用价值

［摘要］　目的　探讨超声评估心力衰竭患者胃肠壁淤血程度的应用价值。方法　招募2023年8月至10月首都医科大学附属北京安贞医院收治的心力衰竭患者32例作为心衰组，另选择同期无心脏疾病的健康人群33名作为对照组。通过胃肠超声及腹部超声测量两组的胃壁、胃壁黏膜下层、肠壁厚度，以及下腔静脉内径、肝静脉内径、门静脉内径、肠系膜上静脉内径。对心衰组进行超声心动图检查，测量左心室射血分数（LVEF）、右室三尖瓣环收缩期位移（TAPSE）及肺动脉收缩压。比较两组临床资料，分析心衰组患者胃肠壁厚度与腹部静脉内径、心脏功能指标间的相关性。结果　心衰组患者胃壁厚度、胃壁黏膜下层厚度、肠壁厚度较对照组增厚，下腔静脉内径、肝静脉内径、门静脉内径、肠系膜上静脉内径较对照组增宽，差异有统计学意义（P<0.05）。心衰组患者LVEF为45.5（25.0，57.7）%，TAPSE为16.0（11.0，18.0）mm，肺动脉收缩压为43.5（28.5，59.0）mmHg。心衰组患者胃壁厚度与TAPSE呈负相关（P<0.05），与门静脉内径呈正相关（P<0.05）；胃壁黏膜下层厚度与TAPSE呈负相关（P<0.05），与肺动脉收缩压、下腔静脉内径、肝静脉内径、门静脉内径呈正相关（P<0.05）；肠壁厚度与TAPSE呈负相关（P<0.05），与下腔静脉内径、肝静脉内径、门静脉内径呈正相关（P<0.05）。心衰组患者胃壁厚度、胃壁黏膜下层厚度、肠壁厚度与LVEF相关性不显著（P>0.05）。结论　超声可以实时监测心衰患者胃肠壁及胃壁黏膜下层厚度指标，可作为评估心衰患者胃肠壁淤血程度的影像学方法。

Application value of ultrasound in evaluating the degree of gastrointestinal wall congestion in patients with heart failure

［Abstract］　Objective　To explore the application value of ultrasound in evaluating the degree of gastrointestinal wall congestion in patients with heart failure. Methods　A total of 32 patients with heart failure who were admitted to Beijing Anzhen Hospital, Capital Medical University from August 2023 to October 2023 were recruited as the heart failure group, and 33 healthy people without heart diseases during the same period were selected as the control group. The thickness of gastric wall, the thickness of the submucosa of gastric wall and the thickness of intestinal wall, inferior vena cava diameter, hepatic vein diameter, portal vein diameter and superior mesenteric vein diameter were measured by using gastrointestinal ultrasound and abdominal ultrasound in both groups. Echocardiography was performed in the heart failure group. Left ventricular ejection fraction(LVEF), right ventricular tricuspid annular plane systolic excursion(TAPSE) and pulmonary artery systolic pressure were measured. The clinical data were compared between the two groups, and the correlation of gastrointestinal wall thickness with abdominal vein diameter and cardiac function indicators in the patients of the heart failure group was analyzed. Results　The thickness of gastric wall, the thickness of the submucosa of gastric wall and the thickness of intestinal wall in the patients of the heart failure group were thicker than those in the patients of the control group, and the inferior vena cava diameter, hepatic vein diameter, portal vein diameter and superior mesenteric vein diameter in the patients of the heart failure group were wider than those in the patients of the control group, and the differences were statistically significant(P<0.05). In the patients of the heart failure group, LVEF was 45.5(25.0, 57.7)%, and TAPSE was 16.0(11.0, 18.0)mm, and pulmonary artery systolic pressure was 43.5(28.5, 59.0)mmHg. In the patients of the heart failure group, gastric wall thickness was negatively correlated with TAPSE(P<0.05) and positively correlated with portal vein diameter(P<0.05), and the thickness of the submucosa of gastric wall was negatively correlated with TAPSE(P<0.05) and positively correlated with pulmonary artery systolic pressure, inferior vena cava diameter, hepatic vein diameter and portal vein diameter(P<0.05), and intestinal wall thickness was negatively correlated with TAPSE(P<0.05) and positively correlated with inferior vena cava diameter, hepatic vein diameter and portal vein diameter(P<0.05). In the patients of the heart failure group, there was no significant correlation of the gastric wall thickness, the thickness of the submucosa of gastric wall and the intestinal wall thickness with LVEF(P>0.05). Conclusion　Ultrasound can monitor the thicknesses of the gastrointestinal wall and the submucosa of gastric wall in patients with heart failure in real time, which can be used as an imaging method to evaluate the degree of gastrointestinal wall congestion in patients with heart failure.