Lee R T, Lord C P, Plappert T, Sutton M S
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Am J Cardiol. 1989 Dec 1;64(19):1366-70. doi: 10.1016/0002-9149(89)90583-3.
To test the hypothesis that the noninvasive evaluation of pulmonary regurgitation can provide accurate estimates of pulmonary artery (PA) diastolic pressures and PA wedge pressures, Doppler echocardiographic studies were performed immediately before bedside PA catheterization in 29 medical intensive care unit patients. The characteristic color flow Doppler signal of pulmonary regurgitation was detected in 19 (66%) patients. In 17 of the 29 patients (59%), the gradient between the right ventricle and PA at end-diastole could be calculated from the pulsed-wave Doppler signal of pulmonary regurgitation using the simplified Bernoulli equation. Right atrial pressure was then estimated by examination of the jugular venous pulse or by electronic transduction of the pressure signal from a previously placed central venous catheter. A noninvasive estimate of PA diastolic pressure was made by adding the clinical estimate of right atrial pressure to the end-diastolic pressure gradient across the pulmonary valve. Pulmonary artery catheterization was then performed and stripchart recordings were interpreted by a physician who was unaware of the noninvasively-estimated PA diastolic pressure. The PA diastolic pressure estimated by Doppler echocardiography correlated closely with that found at catheterization (r = 0.94, mean absolute difference 3.3 mm Hg). The noninvasive estimate of PA diastolic pressure also correlated with the PA wedge pressure (r = 0.87, mean absolute difference 3.8 mm Hg). Therefore, in 59% of medical intensive care unit patients, Doppler echocardiographic evaluation of pulmonary regurgitation allowed accurate noninvasive estimation of PA diastolic pressure.
为验证肺动脉瓣反流的无创评估能否准确估计肺动脉舒张压和肺动脉楔压这一假设，对29例入住医学重症监护病房的患者在床边进行肺动脉导管插入术之前立即进行了多普勒超声心动图研究。19例（66%）患者检测到了肺动脉瓣反流特征性的彩色多普勒信号。29例患者中有17例（59%），可使用简化伯努利方程根据肺动脉瓣反流的脉冲波多普勒信号计算舒张末期右心室与肺动脉之间的压差。然后通过检查颈静脉搏动或通过对先前放置的中心静脉导管压力信号进行电子转换来估计右心房压力。通过将右心房压力的临床估计值与跨肺动脉瓣的舒张末期压力阶差相加，对肺动脉舒张压进行无创估计。随后进行肺动脉导管插入术，并由一位不知道无创估计的肺动脉舒张压的医生解读长条图记录。多普勒超声心动图估计的肺动脉舒张压与导管插入术测得的值密切相关（r = 0.94，平均绝对差值3.3 mmHg）。肺动脉舒张压的无创估计值也与肺动脉楔压相关（r = 0.87，平均绝对差值3.8 mmHg）。因此，在59%的医学重症监护病房患者中，通过多普勒超声心动图评估肺动脉瓣反流能够准确无创地估计肺动脉舒张压。
