彩色多普勒超声对缩窄性心包炎和限制型心肌病的鉴别诊断

目的　评价彩色多普勒超声对缩窄性心包炎 (CP)与限制型心肌病 (RCM )的鉴别诊断价值。方法　应用彩色多普勒超声观察CP、RCM二尖瓣口、三尖瓣口、肺静脉及肝静脉血流状况 ,并用脉冲多普勒取样 ,记录其频谱随呼吸而发生的速率和时间变化 ,并与正常组进行对照。结果　在呼气与吸气时 ,CP组二尖瓣、三尖瓣舒张期速率峰值 (EM,ET)与正常组比较差异有显著性意义 (P <0 .0 5 ) ,且EM 随呼吸变化平均 >3 0 % ,而RCM和正常组平均 <5 % ;收缩期CP组二尖瓣、三尖瓣反流发生率明显低于RCM组 ,且程度较轻 ;CP组吸气与呼气时 ,分别发生肺静脉收缩期血流速率 (S)或舒张期血流速率 (D)值增大 ,而RCM组变化不明显 ;CP和RCM组肝静脉频谱D值和S值随呼吸呈不同的变化 ,而正常组受呼吸变化影响较小。结论　彩色多普勒血流显像技术为CP和RCM的鉴别提供了客观依据。如综合多项多普勒频谱征象并加以全面比较、分析 ,则具有相当的诊断和鉴别诊断价值及较高的敏感性和特异性

Application of color Doppler ultrasonography in differentiating restrictive cardiomyopathy and constrictive pericartiditis

Objective To assess the clinical diagnostic value of color Doppler ultrasogography in restrictive cardiomyopathy and constrictive pericarditis.Methods Observing mitral valvular, tricuspid valvular, pulmonary and hepatic venous flow in 16 cases of restrictive cardiomyopathy (RCM) and 20 cases of constrictive pericardities (CP), getting the spectrum results of above, analysis was made on the spectrum change accompanied with respiration. Twenty cases of normal served as control. Results Both during inspiration and expiration, the maximal peak velocity and time (E M and E T) of mitral and tricuspid valvular in group constrictive pericardities had statistical difference compared with normal group (P< 0.05 ). E M changed with respiration, the average changing aptitude was more that 30%, but were more lower in group RCM and normal. Mitral and tricuspid regurgitation were much milder in group CP than that in group CP. The pulmonary venous S wave or D wave would enhance when respiration in group CP, but in group RCM, this change had been quite slight. As to hepatic venous spectrum, D wave and S wave showed different change with respiration both in group CP and RCM, however which was not so obvious in normal subjects. Conclusions Color Doppler ultrasonography provides a new way to differentiate restrictive cardiomyopathy and constrictive pericarditis, the diagnostic sensitivity and specificity are relatively higher with analysis on multi part vessel spectrum change.