本文關(guān)鍵詞：實(shí)時三維超聲心動圖在評估中、重度肺動脈高壓患者右心室收縮功能中的應(yīng)用價值　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 實(shí)時三維超聲心動圖 常規(guī)超聲心動圖 肺動脈高壓 右心室功能

【摘要】：目的應(yīng)用實(shí)時三維超聲心動圖(real time three-dimensional echocardiography,RT-3DE)技術(shù)定量測量中、重度肺動脈高壓(pulmonary hypertension,PAH)患者的右室容積和射血分?jǐn)?shù),并將其與常規(guī)超聲心動圖參數(shù)進(jìn)行對比研究,旨在探討RT-3DE技術(shù)評估中、重度PAH患者右室收縮功能的臨床價值,并尋找常規(guī)超聲心動圖參數(shù)中可敏感評估不同程度PAH患者右室收縮功能的可靠指標(biāo)。方法30例健康志愿者作為對照組(Ⅰ組),確診的中、重度PAH患者各25例,將其分為中度組(Ⅱ組50mmHgPASP≤70mmHg)、重度組(Ⅲ組PASP70mmHg)。一般情況:測量并記錄每位受檢者的年齡、身高、體重、心率等一般情況。常規(guī)超聲心動圖參數(shù):使用M5S探頭,分別測量并記錄右心房的左右徑(right atrial left and right diameter,RA-D1)、右心房的上下徑(right atrial upper and lower diameter,RA-D2)、右心室基底部的左右徑(right ventricular basal diameter,RV-D)、右室游離壁厚度(right ventricular free wall thickness,RV-FW),三尖瓣最大反流速度(the maximum regurgitant velocity,V)、估測肺動脈收縮壓(pulmonary artery systolic pressure,PASP),右室面積變化分?jǐn)?shù)(right ventricular fractional area change,RVFAC)、三尖瓣環(huán)收縮期峰值速度(tricuspid annular systolic peak velocity,S’)、右室心肌做工指數(shù)(right ventricular myocardial performance index,RIMP)、三尖瓣環(huán)收縮期位移(tricuspid annular systolic displacement,TAPSE)。實(shí)時三維超聲心動圖參數(shù):應(yīng)用4V探頭,連續(xù)采集3個心動周期的右室動態(tài)三維形態(tài)模型并儲存,進(jìn)入Echo PAC工作站,啟用4D Auto RVQ程序,終可得出右室舒張末容積(right ventricular end diastolic volume,RVEDV)、右室收縮期容積(right ventricular systolic volume,RVESV)、右室每博輸出量(right ventricular stroke volume,RVSV)及右室射血分?jǐn)?shù)(right ventricular ejection fraction,RVEF)。探討應(yīng)用RT-3DE技術(shù)評估右室收縮功能的重復(fù)性,并對3組中以上各參數(shù)進(jìn)行對比分析,探討各參數(shù)隨PASP增高的變化趨勢,并分析各參數(shù)與PASP之間,三維參數(shù)RVEF與S’、RIMP、TAPSE、RVFAC間的相關(guān)性。結(jié)果1.一般情況:各組間參與者的年齡、心率、體重、身高的差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)。2.各組間右心結(jié)構(gòu)的比較:各組間RA-D1、RA-D2的差異有統(tǒng)計(jì)學(xué)意義(均P0.01);RV-D在Ⅰ組與Ⅱ組間差異無統(tǒng)計(jì)學(xué)意義(P=0.213),在Ⅰ組與Ⅲ組、Ⅱ組與Ⅲ組間差異有統(tǒng)計(jì)學(xué)意義(均P0.01);RV-FW在Ⅱ組與Ⅲ組間的差異無統(tǒng)計(jì)學(xué)意義(P=0.069),在Ⅰ組與Ⅱ組、Ⅰ組與Ⅲ組間差異有統(tǒng)計(jì)學(xué)意義(均P0.01)。3.各組間RT-3DE參數(shù)之間的比較:RVEDV、RVESV在各組間測值的差異有統(tǒng)計(jì)學(xué)意義(均P0.01);RVEF在Ⅰ組與Ⅱ組、Ⅰ組與Ⅲ組之間差異有統(tǒng)計(jì)學(xué)意義(均P0.01),在Ⅱ組與Ⅲ組之間差異無統(tǒng)計(jì)學(xué)意義(P0.02);RVSV在Ⅰ組與Ⅲ組間有統(tǒng)計(jì)學(xué)意義(P0.01),在Ⅰ組與Ⅱ組、Ⅱ組與Ⅲ組之間差異無統(tǒng)計(jì)學(xué)意義(均P0.02)。4.各組間常規(guī)超聲心動圖參數(shù)之間的比較:TAPSE、RVFAC在各組間的差異均有統(tǒng)計(jì)學(xué)意義(均P0.01);RIMP在Ⅰ組與Ⅱ組、Ⅰ組與Ⅲ組之間差異有統(tǒng)計(jì)學(xué)意義(均P0.01),在Ⅱ組與Ⅲ組之間差異無統(tǒng)計(jì)學(xué)意義(P0.02);S’在Ⅰ組與Ⅲ組間差異有統(tǒng)計(jì)學(xué)意義(P0.01),在Ⅰ組與Ⅱ組、Ⅱ組與Ⅲ組之間差異無統(tǒng)計(jì)學(xué)意義(均P0.02)。5.相關(guān)性研究:整體RVEDV、RVESV、RVEF、RIMP、S’、TAPSE、RVFAC與PASP的相關(guān)系數(shù)分別為0.744、0.822、-0.861、0.602、-0.334、-0.621、-0.725(均P0.01),RVEF與RIMP、S’、TAPSE、RVFAC的相關(guān)系數(shù)分別為:-0.707、0.402、0.574、0.763(均P0.01)。I組中RVEF與RIMP、S’、TAPSE、RVFAC的相關(guān)系數(shù)分別為:-0.68、0.575、0.728、0.787(均P0.01);Ⅱ組中RVEF與以上參數(shù)的相關(guān)系數(shù)分別為:-0.679、0.39、0.672、0.631(均P0.01);III組中RVEF與以上參數(shù)的相關(guān)系數(shù)分別為:-0.559、0.369、0.661、0.744(均P0.01)。6.重復(fù)性研究:同一觀察者測得的RVEF平均差異為(0.22±2.1)%,組內(nèi)相關(guān)系數(shù)為0.897,Blant-Altman圖也顯示重復(fù)測量的RVEF與均值呈一致性的變化趨勢。結(jié)論1.隨著PASP的增高,右室容積逐漸增加而收縮功能逐漸減低。2.RT-3DE技術(shù)可客觀、準(zhǔn)確的評價中、重度PAH患者的右室容積和射血分?jǐn)?shù),可為臨床提供準(zhǔn)確的參考依據(jù)。3.三維RVEF與常規(guī)超聲心動圖參數(shù)的相關(guān)性從高到低依次為RVFAC、RIMP、TAPSE、S’,在評估正常人和中、重度PAH患者的右室收縮功能時,最可靠的常規(guī)超聲心動圖參數(shù)分別為RVFAC、RIMP、RVFAC。
[Abstract]:The purpose of the application of real-time three-dimensional echocardiography (real time three-dimensional echocardiography RT-3DE) technology for quantitative measurement of severe pulmonary arterial hypertension (pulmonary, hypertension, PAH) in patients with right ventricular volume and ejection fraction, and the conventional echocardiographic parameters were compared between the study aims to explore the clinical value of RT-3DE technique in the assessment of systolic function patients with severe PAH right ventricular, and conventional echocardiography can find reliable indicators of different degrees of PAH right ventricular systolic function in patients with sensitive parameter in the evaluation chart. Methods 30 healthy volunteers as control group (group I), diagnosed in severe PAH patients 25 cases, divided into moderate group (Group II, 50mmHgPASP = 70mmHg), severe group (group PASP70mmHg). General: to measure and record each subject's age, height, weight, heart rate. The conventional echocardiographic parameters: using M5S probe, Were measured and recorded right atrial diameter (right atrial left and right diameter, RA-D1), right atrial diameter (right atrial on upper and lower diameter, RA-D2), right ventricular basal diameter (right ventricular basal diameter, RV-D), right ventricular wall thickness (right ventricular free wall thickness three, RV-FW), tricuspid regurgitation velocity (the max maximum regurgitant velocity, V), estimation of pulmonary artery systolic pressure (pulmonary artery systolic pressure, PASP), right ventricular fractional area change (right, ventricular fractional, area change, RVFAC), three tricuspid annular peak systolic velocity (tricuspid annular systolic peak velocity, S "), right ventricular work index (right ventricular myocardial performance index, RIMP), three tricuspid annular systolic displacement (tricuspid annular systolic displacement, TAPSE). Real time 3D echocardiography The dynamic parameters: application of 4V probe, continuous acquisition of 3 cardiac cycles of right ventricular dynamic 3D model and stored into the Echo PAC workstation, 4D enabled Auto RVQ program, the final draw right ventricular end diastolic volume (right ventricular end diastolic volume, RVEDV), right ventricular systolic volume (right ventricular systolic volume, RVESV), right ventricular stroke volume (right ventricular stroke volume, RVSV) and right ventricular ejection fraction (right ventricular ejection fraction, RVEF). The application of RT-3DE technology to assess the reproducibility of the right ventricular systolic function were analyzed, and the 3 groups of the above parameters, probes the trend of each parameter with the increase of PASP, and the analysis between the parameters and the PASP parameters of RVEF and S, three ', RIMP, TAPSE, correlation between RVFAC. Results of the 1. general situation: group participants' age, heart rate, body weight, height difference had no statistical meaning 涔，

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