超声心动图对肺动脉高压和肺静脉高压的非侵入性鉴别诊断研究

目的 确定超声心动图是否能非侵入性鉴别诊断肺动脉高压(PAH)和肺静脉高压(PVH).方法 随机选择56例经超声心动图确定的肺动脉收缩压(PASP)≥40 mmHg的患者,并在7 d内进行心导管检查.依据左室舒张末压或肺毛细血管契压(PCWP)将患者分为PAH组30例,PVH组26例.两组患者应用常规和组织多普勒超声技术分别测定跨二尖瓣舒张早期峰值血流速度E峰,晚期A峰,E/A比值,二尖瓣血流减速时间(DT),舒张早期二尖瓣环运动速度(E')和E/E'值.结果 与PVH组比较,PAH组A峰、DT、PASP及E,增大,而E峰、E/A值和E/E'值却降低.E/E'值和E/A值是PAH和PVH鉴别诊断的最佳指标,其E/E'值和E/A值的ROC曲线下面积分别为97%和91%,而诊断PVH的最佳界值点是E/E'>9.2(敏感性为95%,特异性为97%),E/A>1.7(敏感性为75%,特异性为92%).结论 采用常规和组织多普勒超声技术可正确鉴别PAH和PVH.     

Persistent pulmonary hypertension of the newborn

To protect the identity of the neonate and her family, pseudonyms and fictitious dates have been used, so as to ensure confidentiality as directed by the Nursing Midwifery Council (NMC, 2004). This article explores the aetiology of persistent pulmonary hypertension (PPHN) in a term neonate and discusses nursing management and the management of neonates on high frequency oscillation and inhaled nitric oxide therapy. It is imperative that all staff nursing a neonate on high frequency oscillation and inhaled nitric oxide therapy has a knowledge of the concept, be aware of the problems that may arise and be capable of taking steps in avoiding their occurrence.     

Primary pulmonary hypertension

Dyspnea is the most common symptom of primary pulmonary hypertension, an often fatal disease that has no apparent cause. Decreased cardiac output, congestive heart failure, and increased systemic venous pressure occur as the disease progresses. Use of oxygen therapy and vasodilators improves the prognosis in some patients. Those with little hope for long-term survival may benefit from heart and lung transplantation.     

微小RNA与肺动脉高压

肺动脉高压(PAH)是一类以肺循环阻力增高为主要特征、最终导致右心功能不全、乃至死亡的慢性肺疾病,其病因复杂,预后差.微小RNA(miRNA)是一种内源性的非编码RNA,与PAiH的发生、发展密切相关,可能是潜在的药物治疗靶点.本文主要对miRNA在PAH慢性缺氧、骨形成蛋白Ⅱ型受体(BMPRR2)、apelin-APJ、以及右心功能不全等方面的研究进展进行综述,为探索PAH的发病机制、诊疗研究提供新的方向和思路.     

Diagnosis and treatment of pulmonary hypertension

Primary pulmonary hypertension is a rare disease of unknown etiology, whereas secondary pulmonary hypertension is a complication of many pulmonary, cardiac and extrathoracic conditions. Chronic obstructive pulmonary disease, left ventricular dysfunction and disorders associated with hypoxemia frequently result in pulmonary hypertension. Regardless of the etiology, unrelieved pulmonary hypertension can lead to right-sided heart failure. Signs and symptoms of pulmonary hypertension are often subtle and nonspecific. The diagnosis should be suspected in patients with increasing dyspnea on exertion and a known cause of pulmonary hypertension. Two-dimensional echocardiography with Doppler flow studies is the most useful imaging modality in patients with suspected pulmonary hypertension. If pulmonary hypertension is present, further evaluation may include assessment of oxygenation, pulmonary function testing, high-resolution computed tomography of the chest, ventilation-perfusion lung scanning and cardiac catheterization. Treatment with a continuous intravenous infusion of prostacyclin improves exercise capacity, quality of life, hemodynamics and long-term survival in patients with primary pulmonary hypertension. Management of secondary pulmonary hypertension includes correction of the underlying cause and reversal of hypoxemia. Lung transplantation remains an option for selected patients with pulmonary hypertension that does not respond to medical management.