摘要目的 探讨Tei指数在监测妊娠合并心脏病伴肺动脉高压患者右心室功能中的作用及右心室压力负荷增加对左心室功能的影响. 方法选择妊娠合并心脏病患者58例(先天性心脏病36例,风湿性心脏病14例,心律失常8例),其中26例伴有肺动脉高压(肺动脉高压组),根据肺动脉压力情况分为轻度 [30～49 mm Hg(1 mm Hg=0.133 kPa)] 11例,中度 (50～79 mm Hg) 9例,重度 (≥80 mm Hg) 6例,余32例为非肺动脉高压组.以15例正常妊娠妇女作为对照组,分别计算左、右心室Tei指数. 结果(1)肺动脉高压组右心室等容舒张时间(IRT)为(93±52)ms,等容收缩时间(ICT)为(66±41)ms,较对照组[(39±19)、(38±20) ms]及非肺动脉高压组[(59±12)、(43±19) ms]均明显延长,差异均有统计学意义(P<0.01,P<0.05);而肺动脉高压组右心室射血时间(ET)为(239±46)ms, 较对照组[(299±38) ms]及非肺动脉高压组[(250±41)ms]均明显缩短,差异也均有统计学意义(P<0.01,P<0.05);肺动脉高压组右心室Tei指数为0.72±0.49,明显高于对照组的0.38±0.12和非肺动脉高压组的0.43±0.16,差异也均有统计学意义(P<0.01,P<0.05).(2)肺动脉高压组左心室IRT[(99±27)ms]长于对照组[(88±20) ms]和非肺动脉高压组[(95±15) ms],差异有统计学意义(P<0.01);但3组左心室ICT比较,差异无统计学意义(P>0.01),肺动脉高压组左心室ET为[(202±26)ms]短于对照组[(290±21)ms]和非肺动脉高压组[(220±36)ms],差异有统计学意义(P<0.05,P<0.05);肺动脉高压组左心室Tei指数(0.77±0.38)明显高于对照组(0.43±0.15)和非肺动脉高压组(0.58±0.21),差异也有统计学意义(P<0.01,P<0.05).(3) 右心室Tei指数与肺动脉收缩压具显著正相关关系(r=0.84,P<0.01).(4)肺动脉高压组中,重度患者右心室Tei指数(0.75±0.43)较轻度患者(0.68±0.35)明显升高,差异有统计学意义(P<0.01),较中度患者(0.71±0.14)也明显升高(P<0.05). 结论(1)Tei指数是评价妊娠合并心脏病伴肺动脉高压患者右心室功能简便而准确的多普勒超声新指标,并且Tei指数高低可反映疾病的严重程度;(2)右心室压力负荷增加对左心室功能有明显影响.

abstractsObjective To investigate clinical value of Tei index used for monitoring right ventricular (RV) function in pregnant women complicating cardiac disease accompanying pulmonary hypertension(PH) and the influence on left ventricular(LV) function due to overload pressure of RV. Methods Fifty-eight pregnant women complicating cardiac disease (including 32 cases with congenital heart disease,14 cases with rheumatic heart disease and 8 cases with arrhythmia)were enrolled in this study, among 26 cases coexisted with pulmonary hypertension. According to the pressure of PH, those patients were divided into three groups:11 cases in mild group[30-49 mm Hg (1 mm Hg=0.133 kPa)],9 cases in moderate group (50-79 mm Hg)and 6 cases in severe group (≥80 mm Hg). In the mean time, 15 healthy pregnant women were matched as control. Tei index were measured for LV and RV respectively. Results (1) The isovolumetric relaxation time [IRT,(93±52) ms] and isovolumetric contraction time [ICT,(66±41) ms] of RV in PH group were significantly higher than normal controls [(39±19) ms in IRT and (38±20) ms in ICT] and the other patients without PH group[(59±12) ms in IRT and (43±19)ms in ICT, P<0.01, P<0.05;P<0.05,P<0.05]; however, ejection time (ET) was(239±46) ms significantly shortened in PH group (P<0.05,P<0.01) when compared with (250±41) ms in patients without PH and (299±38) ms in normal controls. Tei index in PH group were 0.72±0.49, which were significantly higher than 0.38±0.12 in normal controls and 0.43±0.16 in patients without PH (P<0.01,P<0.05). (2) The IRT[(99±27)ms] and ICT[(71±40) ms] of LV in PH group were significantly higher than in normal controls [(88±20) ms,(50±24)ms] (P<0.01,P<0.01). ET of LV in PH group [(202±26)ms] were significantly shortened that (290±21)ms in normal controls and (220±36)ms in patients without PH (P<0.01,P<0.05). Tei index of LV in PH group were significantly higher than 0.43±0.15 in normal controls and 0.58±0.21 in patients without PH (P<0.01,P<0.05). (3) Positive correlation between Tei index of RV and pressure of pumonaroy artery were observed (r=0.84, P<0.01). (4) Tei index of RV in severe PH were significantly higher than mild PH (0.75±0.43 vs. 0.68±0.35, P<0.01) and moderate PH (0.75±0.43 vs. 0.71±0.14, P<0.05). Conclusions (1)The Tei index is a novel efficient Doppler index in assessing RV function of pregnant women complicating cardiac disease accompanying PH. And the fluctuation of Tei index might reflect seriousness of the disease. (2) The overload pressure of RV pressure due to PH has significant influence on LV function.