肺动脉高压上腔静脉多普勒血流频谱特点

目的：探讨肺动脉高压(pulmonary arterial hypertension，PAH)患者上腔静脉（superior vena cava，SVC）多普勒血流频谱形态及其参数改变的特点和意义。方法：PAH患者49例，健康成人20例。采用经右侧锁骨上窝切面探查SVC血流速度频谱，观察SVC频谱形态，并测量各波值。结果：PAH组SVC血流频谱形态不同于正常对照组。中度及重度PAH组S波吸气相血流峰值、速度时间积分（velocity time integrals，VTI)及呼吸变化率均显著低于正常对照组（P＜0.05）。各PAH组D波吸气相和呼气相血流峰值、VTI及呼吸变化率均显著低于对照组（P＜0.05）。各PAH组AR波、VR波吸气相和呼气相血流峰值及VTI均显著高于对照组（P＜0.05）。PAH组S波呼气相血流速度峰值（Vexp）与吸气相血流速度峰值（Vins）比值（Vexp/Vins）与肺动脉收缩压成直线正相关（r=0.760, P＜0.001）。结论：PAH患者SVC多普勒血流频谱形态具有其特点，对PAH有一定诊断价值；PAH患者SVC多普勒血流频谱S波吸气相血流峰值速度、VTI和S波Vexp/Vins值及D波、AR波、VR波血流峰值速度、VTI与正常对照组比较有差异，其中S波Vexp/Vins值有可能作为肺动脉压力无创检测的定量指标。

Characteristics of spectra of superior vena cava flow Doppler velocities in pulmonary arterial hypertension

ObjectiveTo explore and evaluate the characteristics of spectra wave shapes and parameters of the superior vena cava (SVC) Doppler flow patterns in patients with pulmonary arterial hypertension(PAH) by echocardiography.MethodsForty-nine patients with PAH as the PAH group and the paired healthy subjects as the control group were included in this study. Transthoracic echocardiography was used, and the spectra of SVC flow Doppler velocities in the right supraclavicular fossa view were examined and recorded. Peak velocity and velocity time integral (VTI) were measured.ResultsThe spectra wave shapes of SVC flow velocity in the PAH group were distinguished from those of the control. The peak velocity and VTI of S waves during inspiration and the rate of respiratory changes of peak velocity of SVC flow Doppler velocity in moderate and severe PAH groups were significantly lower than those of the control (P＜0.05).The peak velocity and VTI of D waves of SVC flow Doppler velocity in the PAH groups were significantly lower than those of the control (P＜0.05). The rate of respiratory changes of peak velocity of D waves in the PAH groups was significantly lower than those of the control (P＜0.05). The peak velocity and VTI of AR, and VR waves of SVC flow Doppler velocity in the PAH groups were significantly higher than those of the control (P＜0.05). Linear regression analysis revealed a significant correlation between pulmonary arterial systolic pressure(PASP) and the Vexp/Vins ratio (r=0.760, P＜0.001). ConclusionThe spectra wave shapes of SVC flow velocity in the PAH groups were distinguished from those of the control which may have some diagnostic value for PAH.The peak velocities and VTI of S waves during inspiration, D waves, AR waves and VR waves of SVC flow Doppler in the PAH groups are different from the control. The ratio of Vexp/Vins of S wave may be a non-invasive quantitative index to detect PAH.