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目的:探讨肺动脉高压患者右心室流出道血流频谱收缩期切迹与右心室收缩功能的关系。方法:收集88例不同原因导致的肺动脉高压患者的临床、血流动力学及超声心动图的资料。根据右心室流出道血流频谱形态分为无切迹组(no notch;NN)、收缩晚期切迹组(late systolic notch;LSN)、收缩中期切迹组(mid-systolic notch;MSN)。以M型超声在心尖四腔心切面三尖瓣环收缩期位移(TAPSE)数值表示右心室收缩功能。结果:肺血管阻力(PVR)在MSN组最高(9.2±3.5)WU,P<0.001,而LSN组为(5.7±3.1)WU,NN组为(3.3±2.4)WU。与LSN组和NN组相比,MSN组TAPSE明显缩短[MSN=(1.6±0.5)cm,LSN=(1.9±0.6)cm,NN=(2.2±0.6)cm,P<0.05]。右心室流出道多普勒加速时间(AT)在MSN组最短(MSN=67±21,LSN=79±18,NN=113±29;MSN vs.NN,P<0.01;MSN vs.LSN,P<0.01;LSN vs.NN,P<0.05)。结论:右心室流出道血流多普勒频谱收缩期切迹可能提示严重的肺动脉高压(PAH)和右心功能不全。
Objective: To investigate the relationship between systolic notch and right ventricular systolic function in right ventricular outflow tract in patients with pulmonary hypertension. Methods: The clinical, hemodynamic and echocardiographic data of 88 patients with pulmonary hypertension were collected. According to the spectral pattern of right ventricular outflow tract blood flow, no notch (NN), late systolic notch (LSN) and mid-systolic notch (MSN) were divided into two groups. The right ventricular systolic function was represented by M-mode ultrasound in the apical four-chamber heart-twitch tricuspid annulus systolic displacement (TAPSE) values. RESULTS: Pulmonary vascular resistance (PVR) was the highest in the MSN group (9.2 ± 3.5) WU, P <0.001 compared with (5.7 ± 3.1) WU in the LSN group and (3.3 ± 2.4) WU in the NN group. Compared with LSN group and NN group, TAPSE of MSN group was significantly shorter than that of LSN group (MSN = (1.6 ± 0.5) cm, LSN = (1.9 ± 0.6) cm, NN = (2.2 ± 0.6) cm, P <0.05). Right ventricular outflow tract Doppler acceleration time (AT) was the shortest in MSN group (MSN = 67 ± 21, LSN = 79 ± 18, NN = 113 ± 29; MSN vs.NN, P <0.01; <0.01; LSN vs. NN, P <0.05). Conclusions: Doppler spectral systolic notch in right ventricular outflow tract may indicate severe pulmonary hypertension (PAH) and right ventricular dysfunction.