0-∞之急诊超声9-实践操作-肺动脉收缩压测量-三尖瓣返流速度法

教育   教育   2024-09-15 08:57   福建  

当右心与肺A之间没有梗阻时,心脏收缩期时二者可以认为是一个相通的整体,这时的肺动脉内压力等于右心室内压力。此时肺动脉收缩压≈右室收缩压=三尖瓣反流压差+右房压。



三尖瓣反流速度法

PASP=RVSP=4VTR²+RAP

PASP:肺动脉收缩压;RVSP:右心室收缩压;VTR:三尖瓣最大反流速度;RAP:右房压力

步骤1:获取心尖四腔心切面




步骤2:使用彩色模式识别三尖瓣返流区域


步骤3:使用CW记录三尖瓣反流频谱,将取样线容积置于反流束中心,测量负向的峰值即为反流峰速度,读取最大反流速度(TRmax,单位m/s),

步骤5:估算右房压力(RAP):可根据下腔静脉宽度和吸气塌陷率来估算


步骤6:三尖瓣反流速度法

PASP=RVSP=4VTR²+RAP

PASP:肺动脉收缩压;RVSP:右心室收缩压;VTR:三尖瓣最大反流速度;RAP:右房压力

根据超声心动图所估测的肺动脉收缩压(PASP),根据其严重程度将其分为三个等级:

轻度肺动脉高压:35≤PASP≤49mmHg

中度肺动脉高压:50≤PASP≤69mmHg

重度肺动脉高压:PASP≥70mmHg

References

Amsallem M, Sternbach JM, Adigopula S, et al. Addressing the Controversy of Estimating Pulmonary Arterial Pressure by Echocardiography. Journal of the American Society of Echocardiography. 2016;29(2):93-102. doi:10.1016/j.echo.2015.11.001

Anavekar NS, Oh JK. Doppler echocardiography: A contemporary review. Journal of Cardiology. 2009;54(3):347-358. doi:10.1016/j.jjcc.2009.10.001 

Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2019;32(1):1-64. doi:10.1016/j.echo.2018.06.004 


Narasimhan M, Koenig SJ, Mayo PH. Advanced echocardiography for the critical care physician: Part 2. Chest. 2014;145:135-142. doi:10.1378/chest.12-2442

Porter TR, Shillcutt SK, Adams MS, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography. Journal of the American Society of Echocardiography. 2015;28(1):40-56. doi:10.1016/j.echo.2014.09.009

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