本文關(guān)鍵詞： 超聲心動描記術(shù) 組織多普勒成像(TDI) 二尖瓣環(huán)運(yùn)動速度 三尖瓣環(huán)運(yùn)動速度 心功能 膿毒癥 膿毒性休克　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的使用傳統(tǒng)二維超聲、組織多普勒成像(tissue Doppler imaging,TDI)監(jiān)測正常人、膿毒癥、膿毒性休克患者心室功能。方法將研究對象分為健康對照組(n=40)、膿毒癥組(n=40)及膿毒性休克組(n=30),在入院24小時內(nèi)先后進(jìn)行傳統(tǒng)二維超聲、TDI檢查。1.使用傳統(tǒng)二維超聲測量左室舒張末內(nèi)徑(left ventricular end diastolic diameter,LVEDD)、左室收縮末內(nèi)徑(left ventricular end systolic diameter,LVESD)、左室射血分?jǐn)?shù)(Ejection fraction,EF)、二尖瓣口舒張?jiān)缙谧畲罅魉?early diastolic mitral blood flow peak velocity,E2)、二尖瓣口舒張晚期最大流速(late diastolic mitral blood flow peak velocity,A2),并計算E2/A2,右室舒張末內(nèi)徑(right ventricular end diastolic diameter,RVd)、右室收縮末內(nèi)徑(right ventricular end systolic diameter,RVs),三尖瓣口舒張?jiān)缙谧畲罅魉?tricuspid valve early diastolic blood flow maximum velocity E3)、三尖瓣口舒張晚期最大流速(late diastolic tricuspid valve blood flow peak velocity A3),并計算E3/A3。2.完成傳統(tǒng)傳統(tǒng)二維超聲參數(shù)后,進(jìn)入TDI模式,測量二尖瓣環(huán)前葉收縮期峰值速度(systolic mitral annular peak velocity,Sm)、舒張?jiān)缙诜逯邓俣?early diastolic mitral annular peak velocity,Em)、舒張晚期峰值速度(late diastolic mitral annular peak velocity,Am),等容收縮時間(isovolumic contraction time,ICT)、等容舒張時間(isovolumic relaxation time,IRT)、射血時間(ejection time,ET),并計算左心心肌運(yùn)動指數(shù)(left ventricular Myocardial performance index)LVMPI=(ICT+IRT)/ET;測量三尖瓣環(huán)中隔瓣收縮期峰值速度(tricuspid annular peak systolic velocity,s')、舒張?jiān)缙诜逯邓俣?early diastolic peak velocity,e')、舒張晚期峰值速度(late diastolic peak velocity,a'),等容收縮時間(ICT)、等容舒張時間(IRT)、射血時間(ET),并計算右心心肌運(yùn)動指數(shù)RVMPI=(ICT+IRT)/ET。觀察比較對照組、膿毒癥組、膿毒性休克組在傳統(tǒng)二維超聲與組織多普勒成像下心功能超聲參數(shù)的改變。結(jié)果1.傳統(tǒng)經(jīng)胸二維超聲監(jiān)測正常組、膿毒癥和膿毒性休克心功能指標(biāo)改變LVEDD、LVESD、LVEF、RVs、RVd在對照組(n=40,44.5±4.3mm、32.7±4.9mm、64.6±5.6、28.0±6.5mm、35.1±6.2mm)、膿毒癥組(n=40,49.6±8.7mm、34.3±9.8mm、56.7±12.2、26.2±7.0mm、33.3±7.3mm)、膿毒性休克組(n=30,依次分別為46.1±9.3mm、30.0±7.9mm、60.3±10.0、29.7±5.2mm、27.4±5.1mm)無明顯統(tǒng)計學(xué)差異(P0.05),E2/A2在膿毒性休克組(n=30,0.7±0.4)明顯低于膿毒癥組(n=40,0.9±0.3),膿毒癥組(n=40,0.9±0.3)明顯低于正常對照組(n=40,1.2±0.4),差異有統(tǒng)計學(xué)意義(P0.05),E3/A3在膿毒癥組(n=40,0.8±0.6)、膿毒性休克組(n=30,0.6±0.80)明顯低于對照組(n=40,1.3±0.7)(P0.05),2.TDI監(jiān)測正常組、膿毒癥和膿毒性休克心功能指標(biāo)改變Am、E/Em、e'、a'、E/e'在膿毒性休克組(n=30,依次分別為8.4±1.6cm/s、10.6±4.6、9.5±4.3 cm/s、9.1±3.6 cm/s、8.6±3.1)、膿毒癥組(n=40,7.2±2.4 cm/s、9.3±3.7、10.5±3.2cm/s、12.5±4.0 cm/s、8.2±2.5)、正常對照組(n=40,9.7±1.8 cm/s、6.3±2.5、10.8±2.4 cm/s、13.6±4.2 cm/s、7.5±1.9)比較,差異無統(tǒng)計學(xué)意義(P0.05);Sm、s'、Em/Am、e'/a'在膿毒性休克組(n=30,依次分別為6.8±4.2 cm/s、8.3±4.2 cm/s、0.6±0.3,0.7±0.6)明顯低于膿毒癥組(n=40,11.6±1.9 cm/s、12.1±4.8 cm/s、0.8±0.2,0.9±0.8),膿毒癥組(n=40,11.6±1.9 cm/s、12.1±4.8 cm/s、0.8±0.2,0.9±0.8)明顯低于正常對照組(n=40,13.5±1.7 cm/s、14.9±3.1 cm/s、1.1±0.4,1.1±0.5),差異有統(tǒng)計學(xué)意義(P0.05);LVMPI在膿毒性休克組(n=30,0.59±0.26)明顯高于膿毒癥(n=40,0.46±0.19)、膿毒癥(n=40,0.46±0.19)明顯高于對照組(n=40,0.39±0.23),差異有統(tǒng)計學(xué)意義(P0.05);RVMPI在膿毒癥(n=40,0.58±0.12)、膿毒性休克組(n=30,0.56±0.16)較正常對照組(n=40,0.46±0.04)明顯升高,差異有統(tǒng)計學(xué)意義(P0.05)。Em膿毒癥(n=40,8.1±2.6cm/s)、膿毒性休克組(n=30,8.1±2.4 cm/s)較正常對照組(n=40,10.6±2.7 cm/s)明顯降低,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.傳統(tǒng)二維超聲測定左室射血分?jǐn)?shù)在三組間無明顯差異。2.TDI參數(shù)反映心肌收縮力改變較傳統(tǒng)二維超聲有優(yōu)勢,反映心肌收縮力TDI參數(shù)Sm、s'在膿毒癥與膿毒性休克均存在顯著性差異性改變。3.傳統(tǒng)二維超聲、TDI技術(shù)均可檢測到膿毒癥早期舒張功能改變。4.TDI具有發(fā)現(xiàn)膿毒癥早期收縮、舒張功能改變的優(yōu)點(diǎn),具有潛在的臨床應(yīng)用價值,但仍需進(jìn)一步大樣本臨床研究證實(shí)。
[Abstract]:The purpose of using the traditional two-dimensional echocardiography, Doppler tissue imaging (tissue Doppler, imaging, TDI) monitoring normal, sepsis, septic shock in patients with ventricular toxicity. Methods the subjects were divided into healthy control group (n=40), sepsis group (n=40) and septic shock group (n= 30), was 24 hours were conventional two-dimensional ultrasound, TDI examination and.1. using a conventional two-dimensional ultrasound measurement of left ventricular end diastolic diameter (left ventricular end diastolic diameter, LVEDD), left ventricular end systolic diameter (left ventricular end systolic diameter, LVESD), left ventricular ejection fraction (Ejection, fraction, EF), early diastolic velocity of mitral valve (early diastolic mitral blood flow peak velocity, E2), late diastolic peak velocity of mitral valve (late diastolic mitral blood flow peak velocity, A2), and calculate the E2/A2, right ventricular end diastolic diameter (right ventricular end diastol IC diameter, RVd), right ventricular end systolic diameter (right ventricular end systolic diameter, RVs), three tricuspid valve mouth early diastolic maximum velocity (tricuspid valve early diastolic blood flow maximum velocity E3), three tricuspid valve port late diastolic maximum velocity (late diastolic tricuspid valve blood flow peak velocity A3), and calculate the E3/A3.2. complete the traditional two-dimensional ultrasound parameters, enter TDI mode, the anterior lobe of mitral annulus peak systolic velocity (systolic mitral annular peak velocity, Sm), early diastolic peak velocity (early diastolic mitral annular peak velocity, Em), late diastolic peak velocity (late diastolic mitral annular peak velocity, Am), isovolumic contraction time (isovolumic contraction time, ICT), isovolumic relaxation time (isovolumic relaxation, time, IRT), ejection time (ejection, time, ET), and calculate the left heart muscle. Dynamic index (left ventricular Myocardial performance index) LVMPI= (ICT+IRT) /ET; three measurement of tricuspid annular peak systolic velocity (tricuspid septum flap annular peak systolic velocity, S'), early diastolic peak velocity (early diastolic peak velocity, E'), late diastolic peak velocity (late diastolic peak velocity, A'), isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), and calculate the right ventricular myocardial performance index RVMPI= (ICT+IRT) /ET. were compared between control group, sepsis group and septic shock group in the conventional echocardiography and tissue Doppler imaging in cardiac function under ultrasound parameters change. Results 1. the traditional transthoracic two-dimensional ultrasound monitoring in normal group, sepsis and septic shock index of heart function change of LVEDD, LVESD, LVEF, RVs, RVd in the control group (n=40,44.5 + 4.3mm, 32.7 + 4.9mm, 64.6 + 5.6,28.0 + 6.5mm, 35.1 + 6.2mm), sepsis group (n=40 ,49.6鹵8.7mm,34.3鹵9.8mm,56.7鹵12.2,26.2鹵7.0mm,33.3鹵7.3mm),鑴?chuàng)姣掓�т紤鍏嬬粍(n=30,渚濇鍒嗗埆涓，

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