Tei指数在监测妊娠合并心脏病伴肺动脉高压患者右心室功能中的作用
Tei지수재감측임신합병심장병반폐동맥고압환자우심실공능중적작용
Tei index for right ventricular function monitoring in pregnant women complicated with cardiac disease and pulmonary hypertension
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2009年 5期 341-344 ,共4页

    张志玲%林建华%陶如琦

    장지령%림건화%도여기

    妊娠并发症,心血管%心脏病%高血压,肺性%心室功能,右%超声心动描记术,多普勒%疾病严重程度指数 妊娠併髮癥,心血管%心髒病%高血壓,肺性%心室功能,右%超聲心動描記術,多普勒%疾病嚴重程度指數
    임신병발증,심혈관%심장병%고혈압,폐성%심실공능,우%초성심동묘기술,다보륵%질병엄중정도지수
    Pregnancy complications,cardiovascular%Heart diseases%Hypertension,pulmonary%Ventricular function,right%Echocardiography,doppler%Severity of illness index
    目的 探讨Tei指数在监测妊娠合并心脏病伴肺动脉高压患者右心室功能中的作用及右心室压力负荷增加对左心室功能的影响. 方法选择妊娠合并心脏病患者58例(先天性心脏病36例,风湿性心脏病14例,心律失常8例),其中26例伴有肺动脉高压(肺动脉高压组),根据肺动脉压力情况分为轻度 [30～49 mm Hg(1 mm Hg=0.133 kPa)] 11例,中度 (50～79 mm Hg) 9例,重度 (≥80 mm Hg) 6例,余32例为非肺动脉高压组.以15例正常妊娠妇女作为对照组,分别计算左、右心室Tei指数. 结果(1)肺动脉高压组右心室等容舒张时间(IRT)为(93±52)ms,等容收缩时间(ICT)为(66±41)ms,较对照组[(39±19)、(38±20) ms]及非肺动脉高压组[(59±12)、(43±19) ms]均明显延长,差异均有统计学意义(P<0.01,P<0.05);而肺动脉高压组右心室射血时间(ET)为(239±46)ms, 较对照组[(299±38) ms]及非肺动脉高压组[(250±41)ms]均明显缩短,差异也均有统计学意义(P<0.01,P<0.05);肺动脉高压组右心室Tei指数为0.72±0.49,明显高于对照组的0.38±0.12和非肺动脉高压组的0.43±0.16,差异也均有统计学意义(P<0.01,P<0.05).(2)肺动脉高压组左心室IRT[(99±27)ms]长于对照组[(88±20) ms]和非肺动脉高压组[(95±15) ms],差异有统计学意义(P<0.01);但3组左心室ICT比较,差异无统计学意义(P>0.01),肺动脉高压组左心室ET为[(202±26)ms]短于对照组[(290±21)ms]和非肺动脉高压组[(220±36)ms],差异有统计学意义(P<0.05,P<0.05);肺动脉高压组左心室Tei指数(0.77±0.38)明显高于对照组(0.43±0.15)和非肺动脉高压组(0.58±0.21),差异也有统计学意义(P<0.01,P<0.05).(3) 右心室Tei指数与肺动脉收缩压具显著正相关关系(r=0.84,P<0.01).(4)肺动脉高压组中,重度患者右心室Tei指数(0.75±0.43)较轻度患者(0.68±0.35)明显升高,差异有统计学意义(P<0.01),较中度患者(0.71±0.14)也明显升高(P<0.05). 结论(1)Tei指数是评价妊娠合并心脏病伴肺动脉高压患者右心室功能简便而准确的多普勒超声新指标,并且Tei指数高低可反映疾病的严重程度;(2)右心室压力负荷增加对左心室功能有明显影响.
    목적 탐토Tei지수재감측임신합병심장병반폐동맥고압환자우심실공능중적작용급우심실압력부하증가대좌심실공능적영향. 방법선택임신합병심장병환자58례(선천성심장병36례,풍습성심장병14례,심률실상8례),기중26례반유폐동맥고압(폐동맥고압조),근거폐동맥압력정황분위경도 [30～49 mm Hg(1 mm Hg=0.133 kPa)] 11례,중도 (50～79 mm Hg) 9례,중도 (≥80 mm Hg) 6례,여32례위비폐동맥고압조.이15례정상임신부녀작위대조조,분별계산좌、우심실Tei지수. 결과(1)폐동맥고압조우심실등용서장시간(IRT)위(93±52)ms,등용수축시간(ICT)위(66±41)ms,교대조조[(39±19)、(38±20) ms]급비폐동맥고압조[(59±12)、(43±19) ms]균명현연장,차이균유통계학의의(P<0.01,P<0.05);이폐동맥고압조우심실사혈시간(ET)위(239±46)ms, 교대조조[(299±38) ms]급비폐동맥고압조[(250±41)ms]균명현축단,차이야균유통계학의의(P<0.01,P<0.05);폐동맥고압조우심실Tei지수위0.72±0.49,명현고우대조조적0.38±0.12화비폐동맥고압조적0.43±0.16,차이야균유통계학의의(P<0.01,P<0.05).(2)폐동맥고압조좌심실IRT[(99±27)ms]장우대조조[(88±20) ms]화비폐동맥고압조[(95±15) ms],차이유통계학의의(P<0.01);단3조좌심실ICT비교,차이무통계학의의(P>0.01),폐동맥고압조좌심실ET위[(202±26)ms]단우대조조[(290±21)ms]화비폐동맥고압조[(220±36)ms],차이유통계학의의(P<0.05,P<0.05);폐동맥고압조좌심실Tei지수(0.77±0.38)명현고우대조조(0.43±0.15)화비폐동맥고압조(0.58±0.21),차이야유통계학의의(P<0.01,P<0.05).(3) 우심실Tei지수여폐동맥수축압구현저정상관관계(r=0.84,P<0.01).(4)폐동맥고압조중,중도환자우심실Tei지수(0.75±0.43)교경도환자(0.68±0.35)명현승고,차이유통계학의의(P<0.01),교중도환자(0.71±0.14)야명현승고(P<0.05). 결론(1)Tei지수시평개임신합병심장병반폐동맥고압환자우심실공능간편이준학적다보륵초성신지표,병차Tei지수고저가반영질병적엄중정도;(2)우심실압력부하증가대좌심실공능유명현영향.
    Objective To investigate clinical value of Tei index used for monitoring right ventricular (RV) function in pregnant women complicating cardiac disease accompanying pulmonary hypertension(PH) and the influence on left ventricular(LV) function due to overload pressure of RV. Methods Fifty-eight pregnant women complicating cardiac disease (including 32 cases with congenital heart disease,14 cases with rheumatic heart disease and 8 cases with arrhythmia)were enrolled in this study, among 26 cases coexisted with pulmonary hypertension. According to the pressure of PH, those patients were divided into three groups:11 cases in mild group[30-49 mm Hg (1 mm Hg=0.133 kPa)],9 cases in moderate group (50-79 mm Hg)and 6 cases in severe group (≥80 mm Hg). In the mean time, 15 healthy pregnant women were matched as control. Tei index were measured for LV and RV respectively. Results (1) The isovolumetric relaxation time [IRT,(93±52) ms] and isovolumetric contraction time [ICT,(66±41) ms] of RV in PH group were significantly higher than normal controls [(39±19) ms in IRT and (38±20) ms in ICT] and the other patients without PH group[(59±12) ms in IRT and (43±19)ms in ICT, P<0.01, P<0.05;P<0.05,P<0.05]; however, ejection time (ET) was(239±46) ms significantly shortened in PH group (P<0.05,P<0.01) when compared with (250±41) ms in patients without PH and (299±38) ms in normal controls. Tei index in PH group were 0.72±0.49, which were significantly higher than 0.38±0.12 in normal controls and 0.43±0.16 in patients without PH (P<0.01,P<0.05). (2) The IRT[(99±27)ms] and ICT[(71±40) ms] of LV in PH group were significantly higher than in normal controls [(88±20) ms,(50±24)ms] (P<0.01,P<0.01). ET of LV in PH group [(202±26)ms] were significantly shortened that (290±21)ms in normal controls and (220±36)ms in patients without PH (P<0.01,P<0.05). Tei index of LV in PH group were significantly higher than 0.43±0.15 in normal controls and 0.58±0.21 in patients without PH (P<0.01,P<0.05). (3) Positive correlation between Tei index of RV and pressure of pumonaroy artery were observed (r=0.84, P<0.01). (4) Tei index of RV in severe PH were significantly higher than mild PH (0.75±0.43 vs. 0.68±0.35, P<0.01) and moderate PH (0.75±0.43 vs. 0.71±0.14, P<0.05). Conclusions (1)The Tei index is a novel efficient Doppler index in assessing RV function of pregnant women complicating cardiac disease accompanying PH. And the fluctuation of Tei index might reflect seriousness of the disease. (2) The overload pressure of RV pressure due to PH has significant influence on LV function.
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