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目的:运用M型超声心动图检测先天性心脏病(CHD)患者的室间隔(IVS)运动M型曲线,探索一种无创评估先天性心脏病患者肺血管阻力(PVR)和平均肺动脉压(PAMP)的新方法。方法:在M型超声心动图中将IVS在舒张末紧邻快速收缩期前向运动的最低边缘定义为基线,将收缩期早期距离基线的最大前向位移定义为a,将舒张早期距离基线的最大后向位移定义为b,计算a/b值。经心导管检查并记录肺动脉收缩压(PASP)、舒张压(PADP)、平均压(PAMP)、肺小动脉嵌压(PAWP),计算肺血流量(QP)以及PVR。定义PAMP≥25 mmHg患者为A组,<25 mmHg患者为B组,比较分析两组a/b值以及其他超声心动图参数。结果:A组患者a/b值为1.99±0.8,B组患者a/b值为0.57±0.3,A组患者a/b值明显>B组,差异具有统计学意义(P<0.05);两组的左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、左室射血分数(LVEF)和左室缩短率(LVFS)值近似,差异无统计学意义(P>0.05);CHD患者a/b值与PVR呈正相关(r=0.804,P<0.01),a/b值与PAMP也呈正相关(r=0.783,P<0.01);通过ROC曲线确定a/b值的临床诊断临界点为0.93(敏感性90.9%,特异性96.6%)。结论:根据室间隔运动M型曲线计算a/b值可以快速且无创地评估CHD患者的PVR和PAMP,在CHD患者的诊断和治疗上具有实际意义。
Objective: To evaluate M-curve of interventricular septum (IVS) in patients with congenital heart disease (CHD) by M-mode echocardiography and to explore the relationship between pulmonary vascular resistance (PVR) and mean pulmonary arterial pressure (PAMP) in patients with congenital heart disease ) Of the new method. Methods: In the M-mode echocardiography, the lowest edge of IVS in the immediate anterior systole of diastole was defined as the baseline. The maximum forward displacement from the baseline in early systole was defined as a. The maximum diastolic distance from the baseline The back displacement is defined as b, and the a / b value is calculated. Cardiac systolic and diastolic blood pressure (PASP), diastolic blood pressure (PADP), mean arterial pressure (PAMP), pulmonary arterial wall pressure (PAWP), pulmonary blood flow (QP) Define PAMP≥25 mmHg patients as group A, <25 mmHg patients as group B, a / b values and other echocardiographic parameters were compared between the two groups. Results The a / b of group A was 1.99 ± 0.8, the value of a / b of group B was 0.57 ± 0.3, the value of a / b of group A was significantly higher than that of group B (P <0.05); The left ventricular end - diastolic diameter (LVDd), left ventricular end - systolic diameter (LVDs), left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVFS) were similar between the two groups, but the difference was not statistically significant (P> 0.05). There was a positive correlation between a / b and PVR (r = 0.804, P <0.01), a / b and PAMP in CHD patients (r = 0.783, P <0.01) The critical point was 0.93 (sensitivity 90.9%, specificity 96.6%). Conclusions: Calculating a / b values based on the M-curve of interventricular septum can evaluate PVR and PAMP rapidly and non-invasively in patients with CHD. It has practical significance in the diagnosis and treatment of CHD.