【摘要】：背景心房顫動(dòng)(以下簡(jiǎn)稱為房顫)是臨床最常見(jiàn)的心律失常之一,其男性發(fā)病率稍高于女性,且隨著年齡的增長(zhǎng)其發(fā)病率增高。房顫持續(xù)時(shí)間達(dá)48小時(shí)即可以發(fā)生左心房?jī)?nèi)的附壁血栓形成,而左心耳是其最常見(jiàn)的附壁血栓形成部位。90%的非瓣膜病性房顫和57%的瓣膜病性房顫患者血栓位于左心耳。因此,準(zhǔn)確評(píng)估房顫患者左心耳的形態(tài)、機(jī)械功能及峰值速度對(duì)房顫患者治療方法和手術(shù)時(shí)機(jī)的選擇及預(yù)后評(píng)估起著非常重要的作用。經(jīng)食管三維超聲歷經(jīng)靜態(tài)、動(dòng)態(tài)、實(shí)時(shí)3個(gè)階段的發(fā)展,目前實(shí)時(shí)三維經(jīng)食管超聲心動(dòng)圖能夠精準(zhǔn)、清晰地顯示左心耳的動(dòng)態(tài)、立體解剖結(jié)構(gòu),更為準(zhǔn)確地提供左心耳的大小、功能指標(biāo)等參數(shù),為臨床評(píng)價(jià)左心耳的形態(tài)、機(jī)械功能及峰值速度提供準(zhǔn)確、可靠的信息。目的探討應(yīng)用實(shí)時(shí)三維經(jīng)食管超聲心動(dòng)圖評(píng)價(jià)房顫患者左心耳形態(tài)及功能的可行性;評(píng)價(jià)房顫患者左心耳機(jī)械功能與峰值速度的變化及兩者之間的相關(guān)性。方法51例房顫患者及38例竇性心律患者行實(shí)時(shí)三維經(jīng)食管超聲心動(dòng)圖檢查,在0°~180°范圍內(nèi)顯示左心耳二維結(jié)構(gòu),于45°左心耳長(zhǎng)軸切面,存儲(chǔ)左心耳二維結(jié)構(gòu)圖像,測(cè)量其開(kāi)口內(nèi)徑及深度。點(diǎn)擊XPlane,通過(guò)調(diào)節(jié)兩個(gè)互相垂直的二維圖像,確保取樣框?qū)⒆笮亩暾j(luò)覆蓋后,啟動(dòng)3D ZOOM模式采集左心耳的三維結(jié)構(gòu)圖像。應(yīng)用脈沖多普勒在距左心耳開(kāi)口1cm處探測(cè)并采集左心耳的血流頻譜,測(cè)量左心耳的最大排空速度(即峰值速度)。檢查過(guò)程中連接胸導(dǎo)聯(lián)心電圖,使得圖像與心電圖同步顯示。房顫患者連續(xù)記錄5個(gè)心動(dòng)周期,竇性心律患者連續(xù)記錄3個(gè)心動(dòng)周期。完成圖像采集后,將圖像存儲(chǔ)至硬盤用以脫機(jī)分析。對(duì)左心耳的三維圖像自由切割顯示其分葉數(shù)目;分別應(yīng)用二維面積法、三維面積法及三維容積法測(cè)量左心耳的排空分?jǐn)?shù),并采用單因素方差分析比較其有無(wú)統(tǒng)計(jì)學(xué)差異;房顫組與竇性心律組左心耳排空分?jǐn)?shù)及峰值速度的比較采用獨(dú)立樣本t檢驗(yàn);應(yīng)用脈沖多普勒測(cè)量左心耳的峰值速度,采用Pearson相關(guān)分析左心耳排空分?jǐn)?shù)與峰值速度的相關(guān)性,測(cè)量的變異性采用Bland-Altman一致性分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果89例患者中左心耳為單葉9例,2葉48例,3葉24例,4葉8例;二維面積法、三維面積法及三維容積法所測(cè)得左心耳排空分?jǐn)?shù)間比較均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);房顫組較竇性心律組左心耳排空分?jǐn)?shù)及峰值速度均減低,差異有統(tǒng)計(jì)學(xué)意義(FEFA-2D=4.374,P=0.000;FEFA-3D=6.440,P=0.001;FEFV-3D=52.469,P=0.004;FPEV=1.640,P=0.004);89例患者左心耳排空分?jǐn)?shù)與峰值速度均呈正相關(guān)(rEFA-2D=0.504,P=0.000;rEFA-3D=0.631,P=0.000;rEFV-3D=0.644,P=0.000);隨機(jī)抽取43例行Bland-Altman一致性分析,二維面積法、三維面積法及三維容積法測(cè)得左心耳排空分?jǐn)?shù)和脈沖多普勒測(cè)得左心耳的峰值速度在觀察者之間和觀察者內(nèi)部均具有較好的一致性。結(jié)論1、不同個(gè)體間左心耳形態(tài)各異,實(shí)時(shí)三維經(jīng)食管超聲心動(dòng)圖能夠清晰顯示左心耳的分葉數(shù)目,測(cè)量其開(kāi)口內(nèi)徑及深度;2、實(shí)時(shí)三維經(jīng)食管超聲心動(dòng)圖可定量評(píng)價(jià)左心耳機(jī)械功能;3、房顫患者左心耳的機(jī)械功能較竇性心律患者降低,即排空分?jǐn)?shù)及峰值速度降低;4、左心耳的峰值速度可間接反映其收縮功能。
[Abstract]:Background Atrial fibrillation (hereinafter referred to as atrial fibrillation) is one of the most common types of arrhythmias in the clinic, with a slightly higher incidence of men and an increase in incidence with age. The duration of atrial fibrillation is up to 48 hours, i.e., mural thrombus in the left atrium can occur, and the left atrial appendage is the most common mural thrombus formation site in the left atrium.90% of non-valvular atrial fibrillation and 57% of the patients with valvular heart disease are located in the left atrial appendage. Therefore, it is very important to accurately assess the shape, mechanical function and peak speed of the left atrial appendage in patients with atrial fibrillation. The three-dimensional transesophageal echocardiography has undergone the development of static, dynamic and real-time three stages, and the real-time three-dimensional transesophageal echocardiography can accurately and clearly display the dynamic and three-dimensional anatomical structure of the left atrial appendage, and more accurately provides parameters such as the size of the left atrial appendage, the function index and the like, To provide accurate and reliable information for the clinical evaluation of the shape, mechanical function and peak speed of the left atrial appendage. Objective To study the feasibility of using real-time three-dimensional transesophageal echocardiography to evaluate the shape and function of left atrial appendage in patients with atrial fibrillation, and to evaluate the relationship between the changes of the mechanical function and the peak velocity of the left atrial appendage in patients with atrial fibrillation. Methods A real-time three-dimensional transesophageal echocardiography was performed in 51 patients with atrial fibrillation and 38 patients with atrial fibrillation. The two-dimensional structure of the left atrial appendage was displayed in the range of 0 擄 to 180 擄, and the two-dimensional structure image of the left atrial appendage was stored in the long axis of the left atrial appendage at 45 擄, and the inner diameter and depth of the opening were measured. Click XPlane to ensure that the three-dimensional structural image of the left atrial appendage is acquired by adjusting the two two-dimensional images that are perpendicular to each other, and ensuring that the sampling frame covers the full envelope of the left atrial appendage. The pulse Doppler was applied to detect and collect the blood flow spectrum of the left atrial appendage at 1 cm from the left atrial appendage opening and measure the maximum emptying rate of the LAA (i.e., the peak velocity). The electrocardiogram of the chest lead is connected in the course of the inspection so that the image is displayed synchronously with the electrocardiogram. The patients with atrial fibrillation recorded a continuous recording of 5 cardiac cycles, and the patients with atrial fibrillation recorded a continuous recording of 3 cardiac cycles. After the image acquisition is complete, the image is stored to the hard disk for offline analysis. the three-dimensional image of the left atrial appendage is free to cut and display the number of the leaves of the left atrial appendage; the two-dimensional area method, the three-dimensional area method and the three-dimensional volume method are respectively applied to measure the emptying score of the left atrial appendage, and the statistical difference is compared by a single-factor analysis of variance; The left atrial appendage emptying score and the peak velocity of the atrial fibrillation group were compared with the peak velocity. The peak velocity of the left atrial appendage was measured by pulse Doppler, and the correlation between the left atrial appendage emptying score and the peak velocity was analyzed with Pearson correlation. The variability of the measured variability was analyzed by the Band-Altman analysis, and the difference was significant between P0.05. Results The left atrial appendage in 89 patients was 9,48,3 and 4, respectively. The two-dimensional area method, three-dimensional area method and three-dimensional volume method had no statistical difference between the left atrial appendage and the left atrial appendage (P0.05). The left atrial appendage emptying score and the peak velocity of the atrial fibrillation group were lower than that of the left atrial appendage (FEFA-2D = 4.374, P = 0.000; FEFA-3D = 6.440, P = 0.001; FEV-3D = 52.469, P = 0.004; FPEV = 1.640, P = 0.004); the left atrial appendage emptying score of 89 patients was positively correlated with the peak velocity (rEFA-2D = 0.504, P = 0.000; rEFA-3D = 0.631, P = 0.000; rEFV-3D = 0.644, P = 0.000); The left atrial appendage (LAA) and the left atrial appendage (LAA) have a good agreement between the observer and the observer, with the left atrial appendage emptying score and the pulse Doppler measured by the method of the random extraction of 43 cases of BLand-Altman analysis, two-dimensional area method, three-dimensional area method and three-dimensional volume method. Conclusion 1. The left atrial appendage is different in different individuals. The real-time three-dimensional transesophageal echocardiography can clearly show the number of the left atrial appendage and measure the inner diameter and depth of the left atrial appendage;2. The real-time three-dimensional transesophageal echocardiography can quantitatively evaluate the mechanical function of the left atrial appendage; and 3, The mechanical function of the left atrial appendage in the patients with atrial fibrillation is lower, that is, the evacuation score and the peak velocity are reduced; and 4, the peak velocity of the left atrial appendage can indirectly reflect its systolic function.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75;R540.45

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