目的:探究高原地区肺炎合并右心功能衰竭体征患儿肺动脉压力和心脏形态功能的特征。方法:回顾性分析107例于2018年1月至2019年8月间住院的高原肺炎合并临床右心衰竭体征患儿的病案资料，以及另外107例年龄、性别、民族相匹配的高原地区肺炎不合并临床右心衰竭体征患儿的病案资料。收集所有患儿的一般资料及临床资料；超声心动图检查包括肺动脉收缩压（systolic pulmonary artery pressure，SPAP）、右心形态［右室前壁厚度、右室舒张末期内径和右房内径］、左心形态［左室后壁厚度、左室收缩末期内径、左室舒张末期内径和左房内径］、心脏功能［右室舒张功能、左室收缩功能与舒张功能］以及是否合并先天性心脏病（congenital heart disease，CHD）；同时收集入院时血清心肌酶谱与心肌蛋白的检查结果。结果:在107例肺炎合并右心衰竭体征的患儿中，30例（28.0%）患儿 的肺动脉收缩压升高，其中轻度升高者19例（17.8%），平均SPAP为（46±4）mmHg；中度升高者6例（5.6%），平均SPAP为（70±6）mmHg；重度升高者5例（4.7%），平均SPAP为110±25 mmHg。合并右心衰体征组较不合并右心衰体征组有显著更高的SPAP（P＜0.001）以及更大的右房与右室（P＜0.01）。2组患者心功能无显著差异（P＞0.05），心肌酶、肌钙蛋白等检查提示正常。肺炎伴右心衰体征组有更多患儿伴有CHD（44.9% vs 31.8%，P=0.028），SPAP与右心大小有显著正相关性（P＜0.001），而与左心大小、心肌酶、心肌蛋白无相关性（P＞0.05）。结论:高原地区肺炎合并右心衰竭体征的患儿常伴有不同程度的肺动脉高压、右心扩大及右心室肥厚。尽管有右心衰竭的体征，但超声心动图及心肌酶与肌钙蛋白检查提示无右心和左心功能衰竭及心肌损伤。临床治疗高原肺炎患儿时，应重视中重度肺动脉高压的易发性和严重性，并需仔细检查患儿是否合并先天性心脏病。
Characteristics of pulmonary arterial pressure and cardiac morphology and function in children with pneumonia and right heart failure in a high altitude area
Objective:To investigate the characteristics of pulmonary artery pressure and cardiac morphology and function in children with pneumonia and right heart failure in a high altitude area.Methods:We reviewed the charts of 107 children diagnosed as having pneumonia with right heart failure and 107 age-, gender-, and ethnic-matched pneumonia children without right heart failure in a high altitude area. Demographic data were collected. Echocardiographic assessments included systolic pulmonary artery pressure (SPAP), cardiac morphology (including thickness of the right ventricular anterior wall and left ventricular posterior wall, and dimensions of the right atrium, left atrium, end-diastolic right ventricle and left ventricle, and end-systolic left ventricle), cardiac function (including end-systolic left ventricle and right ventricle diastolic function and left ventricle systolic and diastolic function), and the presence of congenital heart disease (CHD) or not. Serum myocardial enzymes were measured at admission.Results:In patients with right heart failure, SPAP increased in 30 (28.0%) children; the increase was mild in 19 patients (46±4 mmHg), moderate in 6 (70±6 mmHg), and severe in 5 (110±25 mmHg). Their overall SPAP was significantly higher (P＜0.001) with larger right cardiac morphology measures (P＜0.001~0.003) compared to those without right heart failure. Heart function was not significantly different (P＞0.05) and myocardial enzymes were within normal reference ranges. There were more patients with CHD (44.9% vs 31.8%, P=0.028). SPAP positively correlated with the right heart morphology measures, but not with the left heart morphology measures, myocardial enzymes, or troponin (P＞0.05).Conclusion:Children with pneumonia and right heart failure are often associated with varied degrees of pulmonary hypertension, right heart enlargement, and hypertrophy. Despite clinical signs of right heart failure, echocardiography and myocardial enzymes show no right and left dysfunction or myocardial injury. In clinical treatment of these children, attention should be paid to the predisposition to moderate to severe pulmonary hypertension and CHD.
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