本文選題：左心房　切入點：阻塞性睡眠呼吸暫停綜合征　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 中老年人中阻塞性睡眠呼吸暫停綜合征(OSAHS)發(fā)病率較高,能導(dǎo)致睡眠呼吸紊亂,且具有潛在致死性。本研究旨在通過斑點追蹤成像(STI),對患有和不患有OSAHS研究對象的左心房功能進行比較,得出左房縱向心肌功能在OSAHS患者和健康個體的區(qū)別。證明使用STI評估該類患者左心房功能,可以早期發(fā)現(xiàn)左房的重構(gòu)和損傷,是一種安全有效的新途徑。方法 將120例人群納入本次研究,其中包含90例OSAHS患者和30例健康對照組。所有受檢者都要做多導(dǎo)睡眠呼吸檢測和超聲心動圖并進行斑點追蹤成像,并根據(jù)呼吸暫停低通氣指數(shù)(AHI)結(jié)果將OSAHS患者進行輕度(AHI 5~15),中度(16~30)和重度(AHI30)分組。在屏氣狀態(tài)下獲取連續(xù)3個心動周期的心尖兩腔、心尖四腔動態(tài)圖像并存儲。使用二維、M超、彩色多普勒、組織多普勒技術(shù)測量左室室間隔厚度(IVSd)及后壁厚度(LVPWd)、左室舒張末內(nèi)徑(LVEDD)、等容舒張時間(IVRT)、左室射血分?jǐn)?shù)(LVEF)、二尖瓣口血流頻譜的E峰、A峰和E峰減速時間(Dec T)、二尖瓣舒張早期峰值速度(E)和二尖瓣環(huán)舒張早期心肌速度(E/)之間的比值。計算左室質(zhì)量指數(shù)(LVMI)。在心尖四腔和兩腔切面,利用面積-長度法獲得左房最大容積(LAVmax)、左房最小容積(LAVmin)、左房收縮期容積(LAVprep)并記錄。使用左房容積除以體表面積計算出左房最大容積指數(shù)(LAVImax)、左房最小容積指數(shù)(LAVImin)、左房收縮前容積指數(shù)(LAVIprep)。再根據(jù)相關(guān)公式計算出左心房總的排空分?jǐn)?shù)(LATEF)、被動排空分?jǐn)?shù)(LAPEF)、主動排空分?jǐn)?shù)(LAAEF)和膨脹指數(shù)(LAEI)。將動態(tài)圖像傳輸至Q-LAB9.0軟件進行離線分析,利用斑點追蹤技術(shù)獲得左房應(yīng)變及應(yīng)變率曲線,記錄左室收縮期、舒張早期及舒張晚期左房應(yīng)變(LA_(S-S)、LA_(S-E)、LA_(S-A))及應(yīng)變率(LA_(SR-S)、LA_(SR-E)、LA_(SR-A))。結(jié)果 IVSd及LVPWd自中度組開始增加,OSAHS重度組與健康對照組比較LVMI、IVRT、Dec T有統(tǒng)計學(xué)差異(P0.05)。E/E/在中度組和重度組高于對照組和輕度組,重度組增加更明顯(P0.05)。與對照組相比,OSAHS患者組的LAVI_(max)、LAVI_(prep)、LAVI_(min)都明顯增加,LAPEF減低LAAEF增高(P0.05)。LA_(S-E)、LA_(SR-E)和LA_(S-S)、LA_(SR-S)隨著OSAHS嚴(yán)重程度的增加而減低(P0.05),LA_(S-A)、LA_(SR-A)在中度組輕微升高,而重度組的OSAHS患者LA_(S-A)、LA_(SR-A)降低(P0.05),但與健康對照組相比增高。左房應(yīng)變和應(yīng)變率檢查者內(nèi)變異系數(shù)-0.392~0.064,-0.188~0.019,檢查者間變異系數(shù)為-0.257~0.039,-0.392~0.621。結(jié)論 OSAHS能增加左心的負(fù)擔(dān),導(dǎo)致舒張功能減退,早期可導(dǎo)致左心房重構(gòu),影響左房功能。應(yīng)用斑點追蹤成像對左房功能進行詳細(xì)的評估,在亞臨床階段就可以發(fā)現(xiàn)患有OSAHS人群的左房重構(gòu)和損傷,可以作為一種評估左房功能安全有效的可重復(fù)途徑。
[Abstract]:Objective the incidence of obstructive sleep apnea syndrome (OSAHS) in middle and old people is high, which can lead to sleep apnea disorder. The purpose of this study was to compare left atrial function in subjects with and without OSAHS by speckle tracking imaging. The difference of left atrial longitudinal myocardial function between patients with OSAHS and healthy individuals is obtained. It is proved that using STI to assess left atrial function in such patients can detect early remodeling and injury of left atrium. The study included 90 patients with OSAHS and 30 healthy controls. All subjects underwent polysomnography, echocardiography and dot-tracking imaging. According to the results of apnea hypopnea index (AHII), the patients with OSAHS were divided into three groups: mild AHI _ (15), moderate AHI _ (16 ~ (30)) and severe AHI _ (30). The apical two-chamber and apical four-chamber dynamic images of three consecutive cardiac cycles were obtained and stored in breath-holding state. Color Doppler, Tissue Doppler technique for measuring left ventricular septal thickness (IVSd) and posterior wall thickness (LVPWdN), left ventricular end-diastolic diameter (LVEDDD), isovolumic diastolic time (IVRTT), left ventricular ejection fraction (LVEF), mitral valve flow spectrum (E peak A) and E peak deceleration time (TDec), mitral valve. The ratio between early diastolic peak velocity (E) and mitral annulus early diastolic velocity (E / P). The left ventricular mass index (LVMI) was calculated. The maximum volume of left atrium was obtained by using area-length method, the minimum volume of left atrium was obtained by LAVmax, the minimum volume of left atrium was determined by LAVmin, and the left atrial systolic volume was recorded. The maximum volume index of left atrium was calculated by dividing the area of left atrium by the area of body surface, and the minimum volume index of left atrium was calculated by LAVImaxn, the minimum volume index of left atrium and left atrial volume index were determined by the method of left atrial volume division. The left atrial total emptying fraction (LATEFA), passive emptying fraction (LAPEFA), active emptying fraction (LAAEFG) and expansion index (LAEI) were calculated according to the relative formula. The dynamic image was transmitted to Q-LAB9.0 software for offline analysis. The left atrial strain and strain rate curves were obtained by speckle tracing technique, and the left ventricular systolic period was recorded. Early diastolic and late diastolic left atrial strain (LAS / S) and strain rate (S / S) and strain rate (S / S / S / T). Results IVSd and LVPWd began to increase since the moderate group compared with the healthy control group. There was a significant difference in LVMIIVRTDec T between the moderate group and the control group (P0.05. EP / EP / EP / P / P / P / P / P). The results showed that IVSd and LVPWd were significantly higher in the moderate and severe groups than in the control group and the mild group. In the severe group, the increase was more obvious than that in the control group. In comparison with the control group, the number of LAVISCALVIX / LAVIIIMA / Lago / LAPEF / LAPEF / LAPEF / LAS / S / E / S / S / S / S / S / S / S / S / LASHS / S / S / S / S / LASHS / S / S / S / LASHS / S / S / LASA / S / LAPEF / LAPEF decreased significantly in the patients with OSAHS as compared with the control group, respectively. In the moderate group, there was a slight increase in the number of LAPEF and the increase in the number of LAAEF in the patients with OSAHS and the increase in the level of LAS-SLAA (SR-S-). In severe OSAHS group, LAS-A) decreased P0. 05%, but increased compared with the healthy control group. The coefficient of variation in left atrial strain and strain rate examination was 0. 392 ~ 0. 064 ~ 0. 188 鹵0. 019, and the coefficient of variation was-0. 2577 ~ 0. 039-0. 3922 ~ 0. 621. Conclusion OSAHS can increase the burden of left heart and decrease diastolic function. Early left atrial remodeling can lead to left atrial remodeling, which affects left atrial function. Speckle tracing imaging is used to evaluate left atrial function in detail, and left atrial remodeling and injury can be detected in subclinical patients with OSAHS. It can be used as a repeatable way to evaluate the safety and effectiveness of left atrial function.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R766;R540.45

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