【罂粟摘要】术前2D超声心动图对肝移植受者肺动脉压的评估

术前2D超声心动图对肝移植受者肺动脉压的评估

贵州医科大学     麻醉与心脏电生理课题组

翻 译：安丽    编 辑：柏雪    审 校：曹莹

背景:肺动脉高压(PH)在终末期肝病中并不少见，据报道，当肺动脉平均压(PAP)超过35mmHg时，肝移植(LT)的死亡率呈指数上升。二维超声心动图(2D-Echocardiography)是一种无创、广泛应用且相对便宜的诊断方法，术前二维超声心动图评估肺动脉压(PAP)的临床疗效尚未在肝移植(LT)受者中得到充分评估。本研究评估术前二维超声心动图右心室收缩压(RVSP)与术中右心导管插入术（RHC）测量的PAP的相关性，以及术前RVSP是否可以预测术中PAP。

方法：从2010年10月至2017年2月，共有344名接受术前二维超声心动图和术中右心导管插入术(RHC)的LT受者被纳入该研究，并根据病因、疾病进展和临床情况进行登记和分类。评估了术前二维超声心动图上右心室收缩压（RVSP）与术中右心导管插入术(RHC)的平均收缩压（PAP）的相关性，并评估了RVSP＞50 mmHg对确定平均PAP＞35 mmHg的预测值。

结果：在总体人群中，术前二维超声心动图测得的RVSP与术中RHC测得的PAP，其相关性较弱，其测得的PAP存在显著差异（收缩期 PAP：R=0.27，P<0.001；平均PAP：R=0.24，P<0.001）。RVSP>50mmHg的阳性预测值和阴性预测值分别为37.5%和49.9%。在亚组分析中，两亚型之间的相关性无显著差异。死亡供体型LT患者(收缩期PAP： R =0.129 , P = 0.224;平均PAP：R=0.163， P = 0.126)，腹水控制不佳的患者(收缩期PAP： R = 0.215, P = 0.072;平均PAP：R=0.21， P = 0.079)。

结论：肝移植受者术前二维超声心动图测得的RVSP与术中RHC测得的PAP相关性较弱；因此，术前二维超声心动图可能不是预测术中PAP的最佳工具。对于有肺动脉高压风险的肝移植受者，应考虑RHC。

原始文献来源：Jungchan Park, Myung Soo Park, Ji-Hye Kwon, Ah Ran Oh, Seung-Hwa Lee, Gyu-Seong Choi, Jong Man Kim, Keoungah Kim, and Gaab Soo Kim.2D-echocardiographic assessment of pulmonary arterial pressure in subgroups of liver transplantation recipients.Anesth Pain Med , 2021;16:344-352.Doi.org/10.17085/apm.21028.

英文原文：

2D-echocardiographic assessment

of pulmonary arterial pressure in subgroups of

liver transplantation recipients

Abstract

Background: The clinical efficacy of preoperative 2D-echocardiographic assessment of pulmonary arterial pressure (PAP) has not been evaluated fully in liver transplantation (LT) recipients.

Methods: From October 2010 to February 2017, a total of 344 LT recipients who underwent preoperative 2D-echocardiography and intraoperative right heart catheterization (RHC) was enrolled and stratified according to etiology, disease progression, and clinical setting. The correlation of right ventricular systolic pressure (RVSP) on preoperative 2D-echocardiography with mean and systolic PAP on intraoperative RHC was evaluated, and the predictive value of RVSP > 50 mmHg to identify mean PAP > 35 mmHg was estimated.

Results:  In the overall population, significant but weak correlations were observed (R = 0.27; P < 0.001 for systolic PAP, R = 0.24; P < 0.001 for mean PAP). The positive and negative predictive values of RVSP > 50 mmHg identifying mean PAP > 35 mmHg were 37.5% and 49.9%, respectively. In the subgroup analyses, correlations were not significant in recipients of deceased donor type LT (R = 0.129; P = 0.224 for systolic PAP, R = 0.163; P = 0.126 for mean PAP) or in recipients with poorly controlled ascites (R = 0.215; P = 0.072 for systolic PAP, R = 0.21; P = 0.079 for mean PAP).

Conclusions:  In LT recipients, the correlation between RVSP on preoperative 2D-echocardiography and PAP on intraoperative RHC was weak; thus, preoperative 2D-echocardiography might not be the optimal tool for predicting intraoperative PAP. In LT candidates at risk of pulmonary hypertension, RHC should be considered.

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