儿童支气管哮喘肺动脉压力与右心舒张功能的变化

Changes in the pulmonary artery pressure and the diastolic function of the right ventricle in children with bronchial asthma

摘要:

目的 探讨儿童支气管哮喘（哮喘） 患儿肺动脉压力与右心舒张功能的改变。方法 对２０ 例对照组，１４ 例轻、中型哮喘及１７ 例重型哮喘患儿以多普勒超声心动图测定指标：心率校正肺动脉血流加速时间（ＡＴｃ）；右室射血前期时间（ＲＰＥＰ） ；舒张早期快速充盈峰值流速（Ｅ）；舒张晚期快速充盈峰值流速（Ａ） ，估测肺动脉压及右心舒张功能，同时检测血气分析指标。结果 ①儿童哮喘存在肺动脉高压，重型哮喘组（ＲＰＥＰ／ＡＴ１ ．２６ ±０．１９） 高于轻、中型组（１．１２ ±０．１５） 及对照组（０．８５±０．１４） Ｐ＜ ０ ．０１ 。②对照组（Ｅ／Ａ１．４１±０．２９） 与患儿右心舒张功能指标有明显差异Ｐ＜ ０．０１；重型哮喘患儿存在低氧血症（ＰａＯ２ ７ ．０２ ±０ ．８０ ｋＰａ） 。结论 哮喘患儿存在肺动脉高压和右心舒张功能下降，且随着病情进展，变化显著。

Abstract:

Objective To evaluate the changes in the pulmonary artery pressure and the right ventricular diastolic function in children with bronchial asthma. Methods The acceleration time corrected for heart rate (ATc) and the right ventricular diastolic function were measured to estimate the pulmonary artery pressure by Doppler echocardiography in 20 controls and 31 cases with asthma (14 mild-moderate and 17 severe cases). The blood gas analysis was also surveyed. Results ① The pulmonary artery pressure increased in all the asthmatic patients, and the pressure was much higher in the severe group (RPEP/AT 1.26±0.19) compare to the mild-moderate group (1.12±0.15, P<0.01 ) and control group (0.85±0.14, P<0.01). ②A significant difference in the right ventricular diastolic function was found between the two groups. The right ventricular diastolic function of the severe patients was markedly decreased compared to that of the mild-moderate patients (E/A 0.98±0.34 vs. 1.11±0.29, P<0.01)and controls (E/A 1.41±0.29, P<0.01). The severe asthmatic children always had hypoxemia (PaO 2 7.02±0.80 kPa). Conclusions Pulmonary hypertension and right ventricular diastolic dysfunction are common in bronchial asthmatic children and they are correlated with disease severity.