| [Objective]Use the bedside echocardiography to noninvasively assess the right ventricular function of patients with pulmonary hypertension in intensive care unit(ICU) and find out the valuable echocardiographic parameters for the early diagonsing of right heart failure of patients with pulmonary hypertension.Besides study the risk factors of prognosis of patients in ICU.[Methods]From March 2015 to February 2016, collected the 30 patients who were suffered from pulmonary hypertension in the intensive care unit(ICU) of Dongzhimen hospital affiliated to Beijing university of Chinese medicine as the experimental group, and collected another 33 patients without pulmonary hypertension in ICU as the control group. Besides divided them into death group(19 patients) and survival group(44 patients) according to whether they were dead in 28 days.Collected the patients’ general information (name, sex, age,), vital signs (temperature, heart rate, respiration rate, blood pressure), the first diagnosis, APACHE II score, the application of mechanical ventilation,7 days mortality and 28 day mortality, ICU hospitalization day, TCM syndrome etc.All of the patients are given bedside echocardiography examination.The echocardiographic parameters include the right atrium diameter (RAT), right atrial longitudinal diameter (RAL), right atrial area (RAA), right ventricular’s basal segment diameter (RVD1), right ventricular’s longitudinal diameter (RVD2), right ventricular diameter intermediate section (RVD3), right ventricular free wall thickness (RVFW), the inner diameter of the proximal end of the right ventricular outflow tract (RVOT-Prox-D),the inner diameter of the distal end of the right ventricular outflow tract (RVOT-distal-D), the main pulmonary artery diameter (PAD), and right ventricular fractional area changes (RVFAC), tricuspid annular plane systolic excrusion(TAPSE), right ventricular ejection fraction (RVEF), tricuspid diastolic peak E and A wave ratio (E/A), tricuspid E wave deceleration time (DT), right ventricular function index RIMP (also known as Tei index) etc.All echocardiographic parameters were measured ten times and then averaged.Use the SAS8.2 to establish the database and statistic.[Results]1、The general information analysis:The study collected 63 patients, the experimental group has 30 patients, including 14 males and 16 females, aged 32-89 years old, the mean age is74 ± 13 years old, the average of APACHE II score is 17.9 ± 6.2 points, the rate of mechanical ventilation utilization is 63.3%, ICU length of stay average 9.5 ± 8.3 days,7 days mortality rate is 13.3%,28-day mortality rate is 30.0%. The control group has 33 patients, including 20 males and 13 females, aged 31-88 years old, the mean age is 72 ± 13 years old, the average of APACHE II score is 17.4 ± 7.4 points, the rate of mechanical ventilation utilization is 63.6%, ICU length of stay average 11.5 ± 14.1 days,7 days mortality rate is 21.2%,28-day mortality rate is 30.3%.The death group has 19 patients, including 12 males and 7 females, aged 39-89 years old, the mean age is74 ± 14 years old, the average of APACHE II score is 20.4 ±5.7 points, the rate of mechanical ventilation utilization is 73.7%.The survival group has 44 patients, including 22 males and 22 females, aged 31-89 years old, the mean age is72 ±13 years old, the average of APACHE Ⅱ score is 16.5 ± 7.0 points, the rate of mechanical ventilation utilization is 59.1%.2, The main distribution of disease:the 30 patients of experimental group have 16 case of sepsis(54%)、5 cases of AECOPD (17%)-.4 cases of coronary heart disease (13%)、2 cases of cerebrovascular disease (7%)、1 cases of the disease of diabetes(3%)、1 case of cardiopulmonary resuscitation(3%) and the other 1 cases(3%).The 33 patients of control group have 12 case of sepsis(37%)、3 cases of AECOPD (9%)、4 cases of coronary heart disease (12%)、9 cases of cerebrovascular disease (27%)、1 case of cardiopulmonary resuscitation(3%) and the other 4 cases(12%).The 19 patients of death group have 10 case of sepsis(53%)、1 cases of AECOPD (5%)、2 cases of coronary heart disease (11%)、4 cases of cerebrovascular disease (21%)、1 cases of the disease of diabetes(5%)、1 case of cardiopulmonary resuscitation(5%).The 44 patients of survival group have 18case of sepsis(41%)、7 cases of AECOPD (16%)、6 cases of coronary heart disease (14%)、7 cases of cerebrovascular disease (16%)、1 case of cardiopulmonary resuscitation(2%) and other 5 cases(11%).3、Echocardiographic parameters:the experimental group’s right atrial diameter (RAT) and area (RAA) is bigger than the control group’s(P=0.002,0.001), the base diameter of the right ventricle (RVD1), intermediate diameter portion (RVD3) is wider than the control group’s(P =0.000,0.000), the right ventricular free wall thickness has no significant differences between the two groups (7.2± 1.5vs7.8±2.0, P=0.173), the distal inner diameter of the proximal end of the right ventricular outflow tract(RVOT-distal-D) are wider than the control group’s (P= 0.000), the main pulmonary artery diameter is wider than with the control group’s(P= 0.000), right ventricular function:the Tei index of experimental group is higher than the control group’s(0.48 ± 0.23VS 0.27 ± 0.18, P= 0.000), the E/A of experimental group is higher than the control group’s(1.13 ± 0.28VS 0.99 ± 0.17, P= 0.031), TAPSE, RVFAC, VREF, DT has no significant differences between the two groups (P=0.204,0.082,0.089,0.635).The echocardiographic parameters between death group with survival group has no significant difference.4、Patients’risk factors of prognosis in ICU:APACHEII score was a independent risk factor for hospital mortality in patients in ICU(OR=1.101, P=0.034).5、TCM syndrome type distribution:Lung Qi Deficiency Syndrome is 16 cases, accounting for 53.3%, atmospheric subsidence syndrome is 7 cases, accounting for 23.3%, heart qi deficiency is 4 cases (13.3%), blood stasis syndrome is 3 cases, accounting for 10%.[Conclusion]Bedside echocardiography can quantitatively evaluate the right heart function of patients with pulmonary hypertension in intensive care unit(ICU), Tei index、the right heart’s diameter and the main pulmonary artery diameter are expected to become the promising assessment method of right ventricular function in patients with pulmonary hypertension in ICU.There is no significant difference between patients’ prognosis of pulmonary hypertension with patients’ prognosis of non- pulmonary hypertension. |
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