患者体位
大多数危重患者都只能处于仰卧位进行检查。如果可能,患者取左侧卧位,可以使心脏更靠近胸壁,从而提高胸骨旁切面和心尖切面的成像质量。
操作设置
扫描标记点设置在屏幕的右侧。默认扫描深度为15cm,可根据需要调节。先用B型超声开始扫描。
探头类型
相控(心脏)探头:2.5-5MHz,体积小,可以在肋间扫描。
经胸心彩基础切面获取:
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右心基础切面
1⃣️右心内径测量
4个标准化经胸切面系统评价右心室大小及其正常值。
a 胸骨旁长轴切面近端流出道;>30mm异常,正常范围20-30mm。
b 胸骨侧短轴切面近端流出道;>35mm 异常,正常范围 21-35mm。
c 远端流出道;>27mm 异常,正常范围 17-27mm.
d 心尖四腔切面右心室心尖部;异常:>41mm,正常范围25-41mm。
心尖四腔切面右心室中间;异常:>35mm,正常范围19-35
心尖四腔切面右室内径测量
心尖四腔切面右房内径测量
心尖四腔切面右心长轴测量
取样位置:心尖四腔
舒张末期测量右室大小
在心房心室最宽处测量横径,三尖瓣中点与横径垂直的轴为长径
2⃣️右室流出道测量
3⃣️肺动脉测量
取样位置:胸骨旁短轴主动脉、肺动脉区
右心室流出道内径:在肺动脉瓣瓣下2cm 处测量
肺动脉主干内径:在肺动脉瓣瓣上1cm 处测量
左右肺动脉主干内径:在左右肺动脉主干起始处远心端1cm 处测量
正常值:
参考文献:
[1]中华医学会超声医学分会超声心动图学组. 中国成年人超声心动图检查测量指南[J]. 中华超声影像学杂志, 2016, 25(008):645-666.
[2]Krishnan S, Schmidt GA. Acute right ventricular dysfunction: real-time management with echocardiography. Chest. 2015 Mar;147(3):835-846.
[3]Iriart X, Roubertie F, Jalal Z, Thambo JB. Quantification of systemic right ventricle by echocardiography. Arch Cardiovasc Dis. 2016 Feb;109(2):120-7.
[4]Marwick TH. The role of echocardiography in heart failure. J Nucl Med. 2015 Jun;56 Suppl 4:31S-38S.
[5]Cassady SJ, Ramani GV. Right Heart Failure in Pulmonary Hypertension. Cardiol Clin. 2020 May;38(2):243-255.
[6]Hockstein MA, Haycock K, Wiepking M, Lentz S, Dugar S, Siuba M. Transthoracic Right Heart Echocardiography for the Intensivist. J Intensive Care Med. 2021 Sep;36(9):1098-1109.
[7]DiLorenzo MP, Bhatt SM, Mercer-Rosa L. How best to assess right ventricular function by echocardiography. Cardiol Young. 2015 Dec;25(8):1473-81.
[8]Dandel M, Hetzer R. Evaluation of the right ventricle by echocardiography: particularities and major challenges. Expert Rev Cardiovasc Ther. 2018 Apr;16(4):259-275.
[9]Tan TC, Dudzinski DM, Hung J, Mehta V. Peri-operative assessment of right heart function: role of echocardiography. Eur J Clin Invest. 2015 Jul;45(7):755-66. .
[10]Schneider M, Binder T. Echocardiographic evaluation of the right heart. Wien Klin Wochenschr. 2018 Jul;130(13-14):413-420.
[11]Kasprzak JD, Huttin O, Wierzbowska-Drabik K, Selton-Suty C. Imaging the Right Heart-Pulmonary Circulation Unit: The Role of Ultrasound. Heart Fail Clin. 2018 Jul;14(3):361-376.
[12]Badano LP, Addetia K, Pontone G, Torlasco C, Lang RM, Parati G, Muraru D. Advanced imaging of right ventricular anatomy and function. Heart. 2020 Oct;106(19):1469-1476.
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