本文選題：超聲心動描計(jì)術(shù) + 心室��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用實(shí)時(shí)三維超聲心動圖(real-time three-dimensional echocardiography,RT-3DE)評估骨關(guān)節(jié)退變患者的左心室重構(gòu)和心臟功能影響,并探討該超聲技術(shù)的臨床價(jià)值,以期指導(dǎo)臨床治療。方法:1.選取來我院就診骨關(guān)節(jié)退變患者(研究組)125例,健康志愿者(正常對照組)115例。根據(jù)年齡分別分為兩個亞組,記錄患者身高、體重計(jì)算體表面積(Body surface area,BSA)和體重指數(shù)(body mass index,BMI)。2.首先采用S5-1探頭,獲取心室波群M型圖像,并測量舒張末期室間隔厚度、左心室后壁厚度及左心室舒張末期內(nèi)徑、左心室容積及收縮功能。根據(jù)Devereux校正公式計(jì)算左心室質(zhì)量。3.再于心尖四腔切面,應(yīng)用simpson“雙平面”法,再次測量左心室心內(nèi)膜容積、左心室舒張末期心外膜容積(LVEDVepi)及收縮功能。計(jì)算左心室心肌質(zhì)量(LVM=1.05×(LVEDVepi-LVEDV))、左心室重構(gòu)指數(shù)(LVRI=LVM/LVEDV)。4.換用X5-1探頭,同步連接心電圖,選擇全容積顯像模式,采集連續(xù)4個心動周期圖像,儲存以備脫機(jī)分析。軟件自動得出左心室容積、收縮功能及左心室質(zhì)量。RT-3DE全容積采集并進(jìn)行容積-時(shí)間曲線(volume-time curves,VTC)分析,計(jì)算左心室最大射血速率(peak ejection rate,PER)、左心室最大充盈速率(peak filling rate,PFR)。比較各參數(shù)在各組間及組內(nèi)的差異及相關(guān)性。結(jié)果:1.(1)研究組、正常對照組年齡與LVRI相關(guān)系數(shù)分別是R2=0.711、0.568;(2)研究組、正常對照組體重指數(shù)與LVRI相關(guān)系數(shù)分別是R2=0.787、0.620;(3)病程長短與LVRI相關(guān)系數(shù)是R2=0.655。(4)研究組、正常對照組年齡與PFR相關(guān)系數(shù)分別是R2=0.79、0.749;(5)研究組、正常對照組體重指數(shù)與PFR相關(guān)系數(shù)分別是R2=0.844、0.695;(6)病程長短與PFR相關(guān)系數(shù)是R2=0.661。研究組年齡、BMI與LVRI、PFR相關(guān)性較正常對照組更好。病程長短與LVRI、PFR具有良好相關(guān)性,隨著病程延長,LVRI逐漸增大,PFR逐漸減小。2.研究組LVM、LVRI明顯高于同年齡段正常對照組,且差異均有統(tǒng)計(jì)學(xué)意義(F=14.517、4.318,P0.05)。3.研究組與正常對照組LVEDVI、LVESVI、LVEF、PER差異無統(tǒng)計(jì)學(xué)意義(F=2.156、2.150、2.070、1.775,P0.05)。4.經(jīng)相關(guān)性分析,RT-3DE與M型超聲所測得左心室重構(gòu)參數(shù)的相關(guān)系數(shù)分別為:0.800(LVEDVI)、0.959(LVMI)及0.934(LVRI);RT-3DE與二維超聲所測得左心室重構(gòu)參數(shù)的相關(guān)系數(shù)分別為:0.837(LVEDVI)、0.970(LVMI)及0.942(LVRI),RT-3DE與二維超聲的相關(guān)性優(yōu)于其與M型超聲的相關(guān)性。5.RT-3DE與M型超聲所測得左心室重構(gòu)參數(shù)LVEDVI、LVMI、LVRI差異均有統(tǒng)計(jì)學(xué)意義(t=15.024、3.126、11.376,P0.05)。RT-3DE與二維超聲所測得左心室重構(gòu)參數(shù)LVEDVI、LVMI、LVRI均有統(tǒng)計(jì)學(xué)差異(t=12.805、3.862、5.861,P0.05)。6.經(jīng)Bland-Altman一致性檢驗(yàn),RT-3DE和二維超聲測量LVRI的一致性較好。結(jié)論:1.骨關(guān)節(jié)退變患者年齡、體重指數(shù)、病程長短與左心室重構(gòu)發(fā)生、發(fā)展密切相關(guān)。2.骨關(guān)節(jié)退變患者左心室質(zhì)量和左心室重構(gòu)指數(shù)增加,左心室舒張功能受損嚴(yán)重。3.實(shí)時(shí)三維超聲心動圖相對于常規(guī)二維超聲提供了精確評價(jià)左心室形態(tài)的條件,評價(jià)左心室重構(gòu)和功能具有更高的準(zhǔn)確性和重復(fù)性。4.實(shí)時(shí)三維超聲心動圖測量的LVRI、LVEF、PER、PFR能綜合評價(jià)骨關(guān)節(jié)炎病人左心室重構(gòu)、收縮功能與舒張功能,積極治療,提高患者生存率和生存質(zhì)量。
[Abstract]:Objective: To evaluate the effects of real-time three-dimensional echocardiography (RT-3DE) on left ventricular remodeling and cardiac function in patients with osteoarticular degeneration, and to explore the clinical value of the ultrasound technique in order to guide the clinical treatment. Method: 1. to select 125 cases of patients with osteoarticular degeneration (Study Group) in our hospital. 115 cases of Kang volunteers (normal control group) were divided into two subgroups. The height of the patient was recorded, the body surface area (Body surface area, BSA) and the body mass index (body mass index, BMI).2. first used S5-1 probes to obtain the M image of ventricular wave group, and the thickness of the ventricular septum, the left ventricular posterior wall thickness and the left heart were measured. The internal diameter, left ventricular volume and systolic function at the end of Shi Shuzhang. The left ventricular mass.3. was calculated by the Devereux correction formula and the four cavity of the apical cavity. The left ventricular endocardium volume, the left ventricular epicardial volume (LVEDVepi) and the systolic function were measured again with the Simpson "double plane" method. The left ventricular mass (LVM=1.05 * (L) was calculated (L). VEDVepi-LVEDV), the left ventricular remodeling index (LVRI=LVM/LVEDV).4. was replaced by a X5-1 probe, synchronized electrocardiogram, and full volume imaging mode was selected, 4 consecutive cardiac cycle images were collected and stored for offline analysis. The software automatically acquired left ventricular volume, systolic function and left ventricular mass.RT-3DE full volume collection and volume time curve (V). Olume-time curves, VTC) analysis, calculated the maximum ejection rate of the left ventricle (peak ejection rate, PER), the maximum filling rate of the left ventricle (peak filling rate, PFR). Compare the differences and correlation between the various parameters and the groups. Results: 1. (1) study group, normal exposure group age and LVRI correlation coefficient are respectively; (2) research group, positive The correlation coefficient of body mass index and LVRI in the control group was R2=0.787,0.620, respectively. (3) the correlation coefficient between the course length and the LVRI was R2=0.655. (4), the correlation coefficient of age and PFR in the normal control group was R2=0.79,0.749, respectively. (5) the study group, the body mass index and PFR correlation coefficient of the normal control group were R2=0.844,0.695, (6) the duration of the disease was associated with PFR. The coefficient is R2=0.661. study group age, BMI and LVRI, PFR correlation is better than normal control group. The course length and LVRI, PFR have good correlation. As the course lengthened, LVRI gradually increased, PFR gradually reduced.2. study group LVM, LVRI obviously higher than the same age normal control group, and the difference was statistically significant (F=14.517,4.318 There was no statistically significant difference in LVEDVI, LVESVI, LVEF and PER (F=2.156,2.150,2.070,1.775, P0.05).4. by correlation analysis. The correlation coefficients of the left ventricular remodeling parameters measured by RT-3DE and M type ultrasound were 0.800 (LVEDVI), 0.959 (LVMI) and 0.934 (LVRI), respectively. The correlation of the parameters of left ventricular remodeling measured by two-dimensional ultrasound The numbers were as follows: 0.837 (LVEDVI), 0.970 (LVMI) and 0.942 (LVRI). The correlation between RT-3DE and two-dimensional ultrasound was superior to that of the M type ultrasound. The left ventricular remodeling parameters were measured by.5.RT-3DE and M, and the differences in LVMI and LVRI were statistically significant (t= 15.024,3.126,11.376,) and the parameters of left ventricular remodeling measured by two-dimensional ultrasound DVI, LVMI, LVRI were statistically different (t=12.805,3.862,5.861, P0.05).6. was tested by Bland-Altman consistency. The consistency of LVRI measured by RT-3DE and two-dimensional ultrasound was better. Conclusion: 1. the age, body mass index, course length and left ventricular remodeling in patients with osteoarticular degeneration are closely related to the left ventricular mass and left heart of the patients with.2. bone and joint degeneration. The ventricular remodeling index was increased and the left ventricular diastolic function was severely damaged..3. real-time three-dimensional echocardiography provides a precise evaluation of the left ventricular shape relative to conventional two-dimensional ultrasound. The evaluation of left ventricular remodeling and function with higher accuracy and repetitive.4. real-time three-dimensional echocardiography measurement of LVRI, LVEF, PER, and PFR can be used to evaluate the bone in a comprehensive way. Arthritis patients with left ventricular remodeling, systolic function and diastolic function, are actively treated to improve their survival and quality of life.

【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】：R540.45;R684

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