探讨联合检测二维超声心动图、B型脑钠肽(BNP)、6 min步行试验(6WMT)、呼吸困难量表(MMRC)对慢性阻塞性肺疾病急性加重期(AECOPD)患者右心功能不全的诊断意义。

选取2016年5月至2018年5月我院急诊科收治临床确诊的AECOPD患者作为研究对象，分别收集患者一般资料及进行BNP、6MWT、MMRC、二维超声心动图实验指标测定，统计学分析二维超声心动图指标与BNP、6MWT、MMRC联合检测对AECOPD患者右心功能不全的诊断差异。

共收集AECOPD患者249例，以四项试验指标中任一项阳性结果判断入组患者右心功能不全，则阳性94例(37.8%)，正常者155例(62.2%)。统计学分析，显示二维超声心动图与BNP、6MWT、MMRC判定AECOPD患者发生右心功能不全之间有统计学差异(P<0.05)，二维超声心动图指标与BNP、6MWT、MMRC中任一项联合检测，二维超声指标+BNP组合优于其他组合(同时阳性和同时阴性所占百分比分别为：67.9%，42.6%，54.2%)。二维超声心动图指标联合BNP、6MWT、MMRC中任两项检测，BNP+6MWT+二维超声指标优于其他组合(结果同时阳性和同时阴性所占百分比分别为：44.6%，36.1%，42.2%)。

联合检测二维超声心动图、BNP、6WMT、MMRC对AECOPD患者右心功能不全诊断效果优于单一检测指标，其中BNP+超声指标组优于其他组合，可作为COPD患者合并右心功能不全诊断首选组合方案。

To explore the diagnostic values of combined detection of two-dimensional echocardiography, B-type brain natriuretic peptide (BNP), 6-minute walking test (6MWT) and Modified Medical Research Council dyspnea scale (MMRC) for the right ventricular dysfunction in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

From May 2016 to May 2018, the patients with clinically-confirmed AECOPD in the Emergency Department of our hospital were selected as the research subjects. The general data were collected and BNP, 6MWT, MMRC and two-dimensional echocardiographic experimental indicators were measured. Statistical analysis was made on the difference between the two-dimensional echocardiographic indicators and BNP, 6MWT and MMRC in the diagnosis of the right ventricular dysfunction in AECOPD patients.

Among the 249 patients with AECOPD, 94 (37.8%) were positive and 155 (62.2%) were normal according to the judgment of the right ventricular insufficiency by any of the four test indicators of the two-dimensional echocardiography. Statistical analysis showed that there were significant differences between the two-dimensional echocardiography and BNP, 6MWT and MMRC (P<0.05). The difference between the positive results of the two-dimensional echocardiography and BNP, 6MWT and MMRC was statistically significant by Chi-square test (P<0.05). The positive and negative percentages of the two-dimensional echocardiography combined with any item of BNP, 6MWT and MMRC were 67.9%, 42.6% and 54.2%, respectively, which showed that the two-dimensional echocardiography combined with BNP was superior to the other combinations. The percentages of positive and negative results of the two-dimensional echocardiography combined with any two items of BNP, 6MWT and MMRC were 44.6%, 36.1%, and 42.2%, respectively, which showed that BNP+ 6MWT+ two-dimensional echocardiography was superior to the other combinations.

The combined detection of two-dimensional echocardiography, BNP, 6WMT and MMRC is superior to any single detection in the diagnosis of the right heart insufficiency in the patients with AECOPD, and the BNP+ ultrasound detection group is superior to the other combinations, which can be used as the first choice for the diagnosis of COPD patients with right ventricular insufficiency.