發(fā)布時(shí)間：2018-02-02 01:16

  本文關(guān)鍵詞： 主動(dòng)脈瓣環(huán) 超聲心動(dòng)圖 瓣膜置換術(shù) 左心室功能 組織多普勒　出處：《浙江大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景 主動(dòng)脈瓣病變包括主動(dòng)脈瓣狹窄和主動(dòng)脈瓣關(guān)閉不全,是最常見的心臟瓣膜病變之一。主動(dòng)脈病變程度的加劇必然會(huì)導(dǎo)致血流動(dòng)力學(xué)的改變進(jìn)而影響左室心肌引發(fā)心功能的改變。臨床上,主動(dòng)脈瓣置換術(shù)(aortic valve replacement, AVR)治療主動(dòng)脈瓣病變的常用手術(shù).超聲心動(dòng)圖是AVR術(shù)后臨床標(biāo)準(zhǔn)評(píng)估工具,能夠安全準(zhǔn)確地檢測(cè)、分析主動(dòng)脈瓣及心功能等指標(biāo)。雖然超聲心動(dòng)圖各類技術(shù)的迅猛發(fā)展,但對(duì)設(shè)備、技術(shù)、人員等均有很高的要求,因此在臨床應(yīng)用受到一定的限制。組織多普勒成像技術(shù)(tissue Doppler imaging, TDI)在臨床常見,簡(jiǎn)便易行,又能有效的反映心肌運(yùn)動(dòng)速度和方向、局部結(jié)構(gòu)運(yùn)動(dòng),可精確分析心室壁及瓣環(huán)運(yùn)動(dòng)狀態(tài),觀察心功能的改變。瓣環(huán)作為心臟結(jié)構(gòu)的一部分,TDI可檢測(cè)到瓣環(huán)運(yùn)動(dòng)的改變。眾所周知,二尖瓣環(huán)運(yùn)動(dòng)指標(biāo)已被廣泛應(yīng)用于左心室局部和整體功能的評(píng)估。而相對(duì)來說國內(nèi)外主動(dòng)脈瓣環(huán)運(yùn)動(dòng)研究較少,其檢測(cè)指標(biāo)也不全面,本文就此TDI檢測(cè)主動(dòng)脈瓣環(huán)運(yùn)動(dòng)做了相關(guān)研究,發(fā)現(xiàn)用組織多普勒檢測(cè)主動(dòng)脈瓣環(huán)運(yùn)動(dòng)可作為主動(dòng)脈瓣置換術(shù)后評(píng)估左心室整體功能的指標(biāo)。 目的： 探討組織多普勒技術(shù)檢測(cè)主動(dòng)脈瓣環(huán)運(yùn)動(dòng)在評(píng)估主動(dòng)脈瓣置換術(shù)后患者左心室整體功能方面的臨床價(jià)值。 方法： 選取2014年3月-2014年5月我院主動(dòng)脈瓣膜置換術(shù)后患者20例和20例健康體檢者(對(duì)照組)進(jìn)行研究,于TDI模式下獲取心尖五腔切面(A5C)和心尖三腔切面(A3C)測(cè)定主動(dòng)脈瓣環(huán)4個(gè)壁的組織速度,測(cè)量收縮期峰速(AASa)、舒張?jiān)缙诜逅?AAEa)、舒張晚期峰速(AAAa)。 結(jié)果： 主動(dòng)脈瓣置換術(shù)后患者與體檢對(duì)照組比較,主動(dòng)脈瓣置換術(shù)后患者ARD、AO、 HR, E無顯著改變(P0.05),而IVSd、LVPWd、LVIDd、LVIDs、A、E/Ea、Tei指數(shù)顯著升高(P0.05),主動(dòng)脈瓣環(huán)TDI參數(shù)均顯著減低(P0.001)。相關(guān)性分析顯示,EF、Tei指數(shù)顯著負(fù)相關(guān)(r=-0.514,P=0.001)。主動(dòng)脈瓣環(huán)TDI各參數(shù)均與Tei指數(shù)顯著負(fù)相關(guān)(P0.01),主動(dòng)脈瓣環(huán)TDI參數(shù)SR、AR、AL、AA、 SP、AP與LVEF呈正相關(guān),ER、SL、EL、SA、EA、EP與LVEF無相關(guān)性。 結(jié)論： 主動(dòng)脈瓣置換術(shù)后患者主動(dòng)脈瓣環(huán)運(yùn)動(dòng)明顯降低,術(shù)后左心室功能LVEF明顯降低,E/Ea、Tei指數(shù)升高,與LVEF相比,主動(dòng)脈瓣環(huán)TDI參數(shù)能更好的反映Tei指數(shù)的改變。主動(dòng)脈瓣環(huán)運(yùn)動(dòng)檢測(cè)為評(píng)價(jià)主動(dòng)脈瓣置換術(shù)后左心室整體功能改變提供了新的方法。
[Abstract]:Research background. Aortic valve disease includes aortic stenosis and aortic valve insufficiency. It is one of the most common heart valve diseases. The severity of aortic disease will inevitably lead to hemodynamic changes, thereby affecting the left ventricular myocardium to cause cardiac function changes. Aortic valve replacement (AVR) is a common surgical procedure for the treatment of aortic valve disease. Echocardiography is a standard clinical evaluation tool after AVR, and can be detected safely and accurately. Analysis of aortic valve and cardiac function. Although the rapid development of echocardiography technology, but the equipment, technology, personnel and so on have very high requirements, Therefore, the clinical application of tissue Doppler imaging (TDI) is limited to some extent. Tissue Doppler imaging (TDI) is common in clinical practice, and can effectively reflect the velocity and direction of myocardial movement, local structural movement. It can accurately analyze the motion state of ventricular wall and annulus and observe the changes of cardiac function. As a part of cardiac structure, TDI can detect the changes of valvular motion. Mitral annular motion indices have been widely used in the assessment of left ventricular regional and global function. In this paper, TDI was used to detect aortic annular motion. It was found that the detection of aortic annular motion by tissue Doppler could be used as an index to evaluate the global function of left ventricle after aortic valve replacement. Objective:. To evaluate the clinical value of tissue Doppler technique in assessing the global left ventricular function after aortic valve replacement. Methods:. From March 2014 to May 2014, 20 patients with aortic valve replacement in our hospital and 20 healthy people (control group) were studied. The tissue velocities of the four walls of the aortic annulus were measured by A5C and A3C. the peak systolic velocities of the aortic annulus were measured, the peak velocities of the early diastole and the late diastolic peak velocities were measured, and the end diastolic peak velocities of the aortic annulus were also measured. Results:. Compared with the control group after aortic valve replacement, After aortic valve replacement, there was no significant change of AOA, HRE, E in patients with aortic valve replacement, but there was no significant change in APA, HRE and E in patients undergoing aortic valve replacement, while there was a significant increase in the TDI index of LVIDsU / EaTei, and a significant decrease in the TDI parameters of aortic annulus. The correlation analysis showed that there was a significant negative correlation between TDI parameters of aortic annulus and Tei (r = -0. 514 P0. 001, P = 0. 001, P = 0. 001, P = 0. 001, P = 0. 05, P = 0. 001, P = 0. 05, P = 0. 05, P = 0. 001). There was a significant negative correlation between TDI parameters of aortic annulus and LVEF. There was no correlation between LVEF and LVEF. Conclusion:. After aortic valve replacement, the aortic annular movement decreased significantly, and the left ventricular function LVEF decreased significantly after aortic valve replacement. Compared with LVEF, the LVEF index of left ventricular function decreased significantly. The TDI parameters of aortic annulus can better reflect the change of Tei index. The measurement of aortic annulus motion provides a new method for evaluating the changes of global left ventricular function after aortic valve replacement.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R654.2;R445.1

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