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目的:探讨婴幼儿喘息疾病急性发作期肺动脉压力与右心功能的改变。方法:选择2009年10月至2012年1月收治的婴幼儿喘息性疾病急性发作期病例为研究组(n=100),其中分重症组(n=23)和轻症组(n=77),选择同期健康体检的婴幼儿为对照组(n=100),超声心动图测定肺动脉压(PAP)、右室射血分数(RVEF)、肺血管阻力(PVR)、右室射血时间(RVET)、肺动脉瓣血流加速时间(AT)以及Tei指数,同时进行血气分析。研究组在常规平喘、吸氧治疗基础上予以降低肺动脉压及强心、利尿及钙离子拮抗剂等治疗。结果:100例研究组中肺动脉高压患者34例(34%),其中重症组23例,轻症组11例,无肺动脉高压患者66例(66%);100例健康对照组中肺动脉高压2例(2%),无肺动脉高压者98例(98%),研究组与对照组比较、重症组与轻症组比较,差异均有统计学意义(P<0.05)。血气分析显示,肺动脉高压患者动脉氧分压(PaO2)、血氧饱和度明显低于无肺动脉高压患者且差异有统计学意义(P<0.05);研究组较对照组RVET、AT值减小,PAP、PVR升高,两组比较差异有统计学意义(P<0.05),重症组较轻症组RVET、AT值减小,PAP、PVR升高,两组比较差异有统计学意义(P<0.05)。结论:婴幼儿喘息疾病急性发作期有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。
Objective: To investigate the changes of pulmonary artery pressure and right heart function in infants with wheezing disease during the acute attack. Methods: The cases of acute exacerbation of infants and young children admitted to our hospital from October 2009 to January 2012 were selected as the research group (n = 100), and were divided into severe group (n = 23) and mild group (n = 77) (N = 100), pulmonary arterial pressure (PAP), right ventricular ejection fraction (RVEF), pulmonary vascular resistance (PVR) and right ventricular ejection time (RVET) ), Pulmonary artery flow acceleration time (AT) and Tei index, while blood gas analysis. The study group in the conventional asthma, oxygen therapy to be based on the reduction of pulmonary artery pressure and cardiac, diuretic and calcium antagonists and other treatment. RESULTS: Thirty-four patients (34%) had pulmonary hypertension in 100 study groups, including 23 in severe group, 11 in mild group and 66 in non-pulmonary hypertension group (66%). Two cases of pulmonary hypertension in 100 healthy controls (2%) and no pulmonary hypertension in 98 cases (98%). There was significant difference between the severe group and the mild group in the study group and the control group (P <0.05). Blood gas analysis showed that PAO2 and oxygen saturation in patients with pulmonary hypertension were significantly lower than those without PAH (P <0.05); the values of RVET and AT in the study group were lower than those in the control group, PAP and PVR increased, the differences between the two groups were statistically significant (P <0.05). The severity of mild disease group RVET, AT decreased, PAP, PVR increased, the difference between the two groups was statistically significant (P < 0.05). Conclusion: Pulmonary arterial hypertension and right ventricular diastolic function decline during the acute episodes of asthma in infants and young children, and with the progression of the disease, the changes are significant.