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  本文關(guān)鍵詞： 解剖M型 二維斑點追蹤分層應變 左室心肌功能 冠脈多支病變　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:應用解剖M型及二維斑點追蹤成像技術(shù)評價冠脈多支病變患者左室心肌功能的改變。方法:隨機選取38例心臟結(jié)構(gòu)正常及無明顯節(jié)段性室壁運動異常的冠脈多支病變患者納入MVD組和40例正常人作為對照組,應用常規(guī)二維超聲心動圖(2DE)采集常規(guī)心臟測量切面和左室心尖四腔、兩腔和三腔的二維動態(tài)圖像。應用常規(guī)二維超聲心動圖(2DE)、二維斑點追蹤技術(shù)(2D-STI)、解剖M型(AMM)對兩組左心室相關(guān)參數(shù)進行測量:1.2DE常規(guī)參數(shù)測值包括:舒張末期左室內(nèi)徑(LVDd)及室間隔(IVSTd)、左室后壁厚度(IVSTd),收縮末期左房內(nèi)徑(LAESd)及二尖瓣口脈沖多普勒(PW)血流速度E峰、A峰,二尖瓣環(huán)左室側(cè)壁組織多普勒(TDI)e峰、a峰,并計算E/A,E/e。利用Simpson法測得左室射血分數(shù)(LVEF)。2.2D-STI技術(shù)測量左室收縮功能參數(shù)包括:(1)應用二維斑點追蹤自動功能成像(AFI)分析軟件在機分析左室心尖位各切面,快速獲取左室心肌各節(jié)段收縮期縱向應變值及整體縱向應變值(GLS)。(2)應用二維斑點追蹤分層應變功能脫機分析左室心尖位各切面,獲取各切面心內(nèi)膜下、中層、心外膜下心肌縱向應變值及各切面全層心肌整體縱向應變值。各縱向應變值均以絕對值進行分析。3.2D-STI技術(shù)及AMM測量左室舒張功能參數(shù)包括:(1)應用二維斑點追蹤應變分析軟件脫機分析左室心尖位各切面,測量左室心肌各節(jié)段舒張早期(SrE)及舒張晚期縱向應變率值(SrA),并計算各節(jié)段SrE/SrA。(2)分別在胸骨旁左室長軸切面、左室短軸乳頭肌水平切面解剖M型運動曲線上測量室間隔、左室后壁、前壁及下壁的室壁運動幅度、收縮期達峰時間、舒張期松弛時間及收縮期達峰時間與舒張期松弛時間比值。結(jié)果:1.冠狀動脈造影結(jié)果:MVD組冠狀動脈造影顯示側(cè)支血管豐富的病例數(shù)目明顯增多。2.2DE常規(guī)參數(shù)比較結(jié)果:與對照組比較,MVD組LVDd、IVSTd、LVPWTd、LAESd、E峰、E/A、a峰、LVEF差異均無統(tǒng)計學意義(P0.05),e峰減低、A峰及E/e升高,差異均有統(tǒng)計學意義(P0.05)。3.2D-STI測量左室收縮功能參數(shù)比較結(jié)果:(1)與對照組比較,MVD組患者整體GLS降低無統(tǒng)計學意義(P0.05),但是MVD組患者基底段、中間段水平的后間隔及左室下壁縱向應變減低,差異有統(tǒng)計學意義(P0.05)。(2)與對照組比較,MVD組左室心尖位各切面心內(nèi)膜下心肌縱向應變均減低,差異均有統(tǒng)計學意義(P0.05),但左室心尖位各切面中層心肌、心外膜下心肌縱向應變及各切面全層心肌整體縱向應變減低均無顯著差異(P0.05)。4.2D-STI及AMM測量左室舒張功能參數(shù)比較結(jié)果:(1)與對照組比較,MVD組患者部分節(jié)段SrE/SrA比值減低,差異均有統(tǒng)計學意義(P0.05)。(2)兩組間左室前壁、下壁、后壁、室間隔運動幅度及收縮期達峰時間差異均無統(tǒng)計學意義(P0.05)。與對照組比較,MVD組患者舒張期松弛時間延長,收縮期達峰時間與舒張期松弛時間比值減低,差異均有統(tǒng)計學意義(P0.05)。結(jié)論:1.二維斑點追蹤分層應變技術(shù)可以評價冠脈多支病變患者左室心肌縱向分層應變,為判斷冠脈多支病變患者早期左室收縮功能損害提供一種新的評價方法。2.AMM聯(lián)合2D-STI可以對冠脈多支病變患者左室局部舒張功能進行有效評價,有助于簡便、無創(chuàng)地篩選出無癥狀冠脈多支病變患者。
[Abstract]:Objective: the application of anatomical M mode and two dimensional speckle tracking imaging assessment of coronary multivessel disease in patients with left ventricular function changes. Methods: randomly selected 38 patients with normal heart structure and no obvious coronary segmental wall motion abnormalities in patients with multivessel disease in MVD group and 40 cases of normal people as control group, using conventional two dimensional echocardiography (2DE) acquisition routine measurement of the heart section and the left ventricular apical four chamber, two chamber and three chamber of the two-dimensional dynamic images. The application of conventional two-dimensional echocardiography (2DE), two dimensional speckle tracking imaging (2D-STI), M (AMM) anatomical measurement of related parameters of the two groups of left ventricle: 1.2DE the conventional parameters measured include: left ventricular end diastolic diameter (LVDd) and interventricular septum (IVSTd), left ventricular posterior wall thickness (IVSTd), left atrial end systolic diameter (LAESd) and mitral pulse Doppler (PW) blood flow velocity of E peak, A peak of mitral annulus left ventricular lateral wall tissue Doppler (TDI) e peak, a peak, E/e. and E/A were calculated and measured left ventricular ejection fraction (LVEF) by Simpson method including the parameter measurement of left ventricular systolic function in.2.2D-STI (1): automated function imaging using two-dimensional speckle tracking (AFI) analysis software in machine analysis of left ventricular apical sections, fast get the left ventricular segmental systolic longitudinal strain and global longitudinal strain (GLS). (2) layered strain analysis of left ventricular function offline apical sections by two-dimensional speckle tracking for each section of subendocardial, subepicardial middle, longitudinal strain value and each section of full thickness myocardial global longitudinal strain the longitudinal strain values. Values are in absolute value of.3.2D-STI and AMM to measure the left ventricular diastolic function parameters include: (1) software offline analysis of left ventricular apical sections analysis using two-dimensional speckle tracking strain measurement of left ventricular myocardial segments early diastolic (SrE ) and late diastolic longitudinal strain rate (SrA), and calculate each segment of SrE/SrA. (2) respectively in the parasternal long axis view, left ventricular papillary muscle level in short axis view anatomy M motion curve measurement of interventricular septum, left ventricular posterior wall, anterior wall and inferior wall motion. Shrink during peak time, relaxation time and time to peak systolic and diastolic relaxation time ratio. Results: 1. the results of coronary angiography: group MVD coronary angiography showed that the number of cases of collateral vessels rich significantly increased.2.2DE conventional parameter comparison results: compared with control group, MVD group, LVDd, IVSTd, LVPWTd, LAESd. The peak of E, E/A, a peak, LVEF showed no significant difference (P0.05), e peak A peak decreased and E/e increased, the differences were statistically significant (P0.05) compared the parameters measurement of left ventricular systolic function in.3.2D-STI results: (1) compared with the control group, GLS MVD group had no statistical significance Yi (P0.05), but MVD group of patients with basal segment, middle segment level after the interval and left ventricular wall under longitudinal strain decreased, the difference was statistically significant (P0.05). (2) compared with the control group, MVD group, left ventricular apical section of the subendocardial myocardial longitudinal strain were decreased, the differences were statistically meaning (P0.05), but the middle section of left ventricular apical epicardial myocardial longitudinal strain and myocardial each section of full thickness myocardial longitudinal strain decreased overall there was no significant difference (P0.05).4.2D-STI and AMM measurement of left ventricular diastolic function parameters comparison results: (1) compared with the control group, patients in group MVD segment the ratio of SrE/SrA decreased, the differences were statistically significant (P0.05). (2) between the two groups of left ventricular anterior wall, inferior wall, posterior wall, ventricular septal motion and systolic peak time showed no significant difference (P0.05). Compared with the control group, MVD group of patients with diastolic relaxation time, systolic The peak time and relaxation time ratio decreased, the differences were statistically significant (P0.05). Conclusion: 1. dimensional speckle tracking strain layered technology can evaluate the coronary multivessel disease of left ventricular myocardial longitudinal layered strain, for the judgment of multivessel coronary disease in patients with early left ventricular systolic dysfunction and provide a new evaluation method combined with.2.AMM 2D-STI of multivessel coronary disease in patients with left ventricular diastolic function for effective evaluation, contribute to the simple, noninvasive screening of asymptomatic patients with multivessel coronary disease.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R540.45;R541.4

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