经食管超声多普勒观察肺静脉及二尖瓣血流估测肺毛细血管楔嵌压的新方法

目的：本文探讨应用多普勒超声联系观察肺静脉血流（PVF）和二尖瓣前向性血流（MIF）估测平均肺毛细血管楔嵌压（MPCWP）的新途径。方法：研究了20例正常人和28例先天性心脏病患者PVF和MIF的特征，并将其多普勒参数及两者结合衍生的指标与经导管检查测得的MPCWP进行相关比较分析。结果：患者房缩期PVF的流速时间积分与周期MIF的流速时间积分之比（Zi/Ai)与MPCWP相关性最佳（MPCWP＝－7．88＋24．13xZi/Ai,SEE=3.24mm Hg,r=0.86,P＜0.01)，且多元逐步回归表明：SBP、DBP、HR、age均不影响之。以Zi/Ai＞1．05估测MPCWP＞18mmHg的敏感性100％、特异性93％。结论：Zi/Ai是判定患者MPCWP正常与否的较好指标，本研究提示超声联系观察PVF和MIF可以为无创估测MPCWP提供新途径。

Estimation of Mean Pulmonary Capillary Wedge Pressure from Transesophageal Pulsed Doppler Echocardiography of Pulmonary Venous Flow and Mitral Inflow

Objective:To determine whether investingating pulmonary venous flow(PVF)and mitral inflow(MIF)by transesophageal pulsed Doppler echocardiography could provide a new approach to estimate mean pulmonary capillary wedge pressure.Methods:The characteristics of PVF and MIF in 20 normal subjucts and 28 consecutive patients with congenital heart diseases were prospectively studied.The Doppler variables of PVF and MIF in patients were correlated with MPCWP measured by cardiac catheterzation.Results:The ratio of Zi(the velocity time integral of reversal flow in pulmonary venae during atrial constraction)to Ai(the velocity time integral of mitral inflow at atrial constraction)correlated best with MPCWP(MPCWP=-7 88 24 13xZi/Ai,SEE=3 24mmHg,r=0 86, P <0 01).A multiple stepwise linear regression analysis showed that blood pressure,heart rate and age did not significiently alter this correlation.A Zi/Ai of more than 1 05 was both a senstive(100%)and specific(93%)marker of predicting a MPCWP of more than 18mmHg.Conclusions:It is reliable for us to recognize whether the MPCWP was normal or abnormal using Zi/Ai in patients with congenital heart diseaes.Thus,our method might offer a new approach to the noninvasive estimation of MPCWP.