肺动脉高压患者肺循环参数不同测量方法的可靠性

目的 应用不同方法测量肺动脉高压患者肺循环参数,评价VigilanceⅡ系统连续热稀释法、经胸超声心动图(transthoracic echocardiography,TTE)法预测肺总阻力(total pulmonary resistance,TPR)的可靠性,并评价TTE测量肺动脉压的临床价值。方法 选择复旦大学附属中山医院心内科收治的38例肺动脉高压患者(21例有心内分流,17例无心内分流)的TTE及右心导管测量肺循环参数,同时应用VigilanceⅡ系统连续热稀释法、Fick法、TTE法测量TPR,并进行回归相关分析。结果 热稀释法、TTE法与Fick法所测量的TPR值之间均有相关性,无心内分流患者的相关性高于有心内分流患者,有心内分流患者TTE法与Fick法测量值之间线性关系无统计学意义,全部患者及无心内分流患者热稀释法、TTE法测得的TPR与Fick法测量值之间的线性关系均有统计学意义。TTE与右心导管测量肺动脉压力值之间有相关性,无心内分流患者之间的相关性高于有心内分流患者。结论 VigilanceⅡ系统连续热稀释法可精确估测无心内分流患者的TPR；TTE能够很好地估测肺动脉压力,可以作为估测无心内分流患者TPR的一种方法,但估测有心内分流患者TPR时要慎重。
Objective To evaluate the reliability of continuous thermodilution of VigilanceⅡ monitor system and transthoracic echocardiography (TTE) in measuring total pulmonary resistance (TPR) in patients with pulmonary arterial hypertention(PAH), and to evaluate the clinical value of TTE in assessing pulmonary pressure. Methods Thirty-eight PAH patients hospitalized in Zhongshan Hospital of Fudan University were recruited, among whom 21 had intracardial shunt.Pulmonary hemodynamic parameters were measured by transthoracic echocardiography (TTE) and right catheterization (RCH) examination. TPR was obtained with continuous thermodilution technique of Vigilance Ⅱ monitor system, Fick′s principle and TTE respectively. Results The TPR measured byTTE and continuous thermodilution were correlated with TPR by Fick′s principle, and it was morecorrelative in patients without intracardial shunt than those with intracardial shunt.However, regression models of TPR by TTE and Fick′s principle in patients with intracardial shunt were not statistically significant. TPR measured by continuous thermodilution and TTE in all the patients and patients without intracardial shunt was significantly correlated with TPR measured by Fick′s principle. Pulmonary arterial pressures (PAP) measured by TTE and RCH were more correlative in patients without intracardial shunt than those with intracardial shunt. Conclusions Continuous thermodilution of Vigilance Ⅱ monitor system can accurately estimate the TPR in patients without intracardial shunt. TTE can be used to estimate PAP and TPR those without intracardial shunt accurately, while it should be careful to apply TTE in estimating patients with intracardial shunt.