本文關(guān)鍵詞： 超聲心動(dòng)圖 三維近端等速表面積法 二尖瓣狹窄 Nyquist速度極限 三維近端等速表面積法 二尖瓣反流 定量技術(shù)　出處：《華中科技大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：目的探討三維近端等速表面積(Three-dimensional proximal isovelocity surface area,3D PISA)法測(cè)量二尖瓣狹窄患者二尖瓣口面積(Mitral valve Area, MVA)的準(zhǔn)確性,并探討應(yīng)用3D PISA法測(cè)量MVA的最佳Nyquist速度極限。 方法對(duì)20例二尖瓣狹窄(Mitral stenosis,MS)患者分別采用胸骨旁切面直接勾勒法、二維近端等速表面積(Two-dimensional proximal isovelocity surface area,2D PISA)法及3D PISA法測(cè)量MVA,以胸骨旁切面直接勾勒法測(cè)量的MVA為參照標(biāo)準(zhǔn),分析不同的Nyquist速度極限下,上述3種方法測(cè)量MVA的異同。 結(jié)果在不同的Nyquist速度極限(32cm/s、26cm/s、19cm/s)時(shí),3D PISA法測(cè)量MVA均不同；隨著Nyquist速度極限的增加,胸骨旁切面直接勾勒法與3D PISA法測(cè)量的MVA差值逐漸增加,在Nyquist速度極限為19cm/s時(shí)：①胸骨旁切面直接勾勒法與3D PISA法、2D PISA法測(cè)量的MVA差值均最��；②與2D PISA法測(cè)量的MVA相比,3D PISA法測(cè)量的MVA與胸骨旁切面直接勾勒法測(cè)量的MVA更接近。③2D PISA法、3D PISA法測(cè)量的MVA與胸骨旁切面直接勾勒法測(cè)量的MVA均有相關(guān)性,相關(guān)系數(shù)分別為(r=0.88,r=0.98)。④與2D PISA法測(cè)量MVA相比,3D PISA法與二維胸骨旁切面直接勾勒法測(cè)得的MVA有更好的一致性。結(jié)論在Nyquist速度極限為19cm/s時(shí),3D PISA法測(cè)量的二尖瓣狹窄患者M(jìn)VA與胸骨旁短軸切面直接勾勒法測(cè)量的MVA差值最小；3D PISA法與二維胸骨旁切面直接勾勒法測(cè)得的MVA有更好的一致性 目的：探討三維近端等速表面積(Three-dimensional proximal isovelocity surface area,3D PISA)法定量二尖瓣反流的準(zhǔn)確性,并探討應(yīng)用3D PISA法定量二尖瓣反流(mitral regurgitation, MR)的最佳Nyquist速度極限。 方法：選取24例二尖瓣反流患者,其中12例二尖瓣脫垂,8例風(fēng)濕性心臟病及4例功能性反流的患者作為研究對(duì)象,比較經(jīng)胸二維近端等速表面積(Two-dimensional proximal isovelocity surface area,2D PISA)法及3D PISA法測(cè)量二尖瓣有效反流口面積,流量差值法計(jì)算的二尖瓣有效反流口面積作為比較的參考。 結(jié)果：當(dāng)選擇不同Nyquist速度極限(55cm/s,43cm/s,37cm/s,28cm/s,18cm/s),3D PISA法測(cè)量的二尖瓣有效反流口面積不同,當(dāng)Nyquist速度極限從28cm/s逐漸增加時(shí),3DPISA法測(cè)量的二尖瓣反流有效反流口面積與參照方法測(cè)量的結(jié)果差值逐漸增加,在選擇的Nyquist速度極限為28cm/s時(shí)：流量差值法計(jì)算的有效反流口面積與3D PISA法計(jì)算的有效反流口面積差值最小為0.06±0.06cm2,其差值百分比為9±8%；3D PISA法及2D PISA法測(cè)得的二尖瓣有效反流口的面積與流量差值法計(jì)算的二尖瓣有效反流口面積均有相關(guān)性,相關(guān)系數(shù)分別為0.96、0.90,采用三維PISA法測(cè)量的二尖瓣有效反流口面積與流量差值法測(cè)量的結(jié)果具有較高的一致性。 結(jié)論：選擇的Nyquist速度極限為28cm/s,3D PISA法較2D PISA法能夠更加準(zhǔn)確地定量二尖瓣關(guān)閉不全患者的反流,同時(shí)三維PISA法操作簡(jiǎn)便,可能成為臨床評(píng)價(jià)二尖瓣反流量的新方法。
[Abstract]:Objective to investigate the accuracy of three-dimensional proximal isovelocity surface area3 (3D PISA) method in measuring mitral valve area (MVA) in patients with mitral stenosis, and to explore the best Nyquist velocity limit of MVA by using 3D PISA method. Methods Twenty patients with mitral stenosis were examined by direct parsternal cross-sectional method, Two-dimensional proximal isovelocity surface area2D PISA-2D and 3D PISA, respectively. The MVA measured by direct parasternal section was used as the reference standard. The similarities and differences of the three methods mentioned above for MVA measurement under different Nyquist velocity limits are analyzed. Results at different Nyquist speed limits of 32 cm / s ~ 26 cm / s ~ (19 cm / s), 3D PISA was different in measuring MVA, and with the increase of Nyquist velocity limit, the difference of MVA measured by direct delineation method and 3D PISA method increased gradually. When the velocity limit of Nyquist is 19 cm / s, the MVA difference between direct drawing method and 3D PISA method / 2D PISA method is the least than that of MVA with 3D PISA method and MVA with direct delineation method with parasternal section method compared with MVA measured by 2D PISA method. There was a correlation between the MVA measured by the 3D PISA method and the MVA measured by the direct drawing method on the parasternal section of the sternum, which was close to .32D PISA method and 3D PISA method. The correlation coefficients were 0.984.Compared with 2D PISA method, the MVA measured by 3D PISA method and two-dimensional parasternal section method were in better agreement. Conclusion the MVA of mitral stenosis patients measured by 3D PISA method at Nyquist velocity limit of 19 cm / s is better than that of 2D PISA method. There is a better agreement between the MVA measured by 3D PISA method and that measured by direct drawing method of parasternal short axis section with the method of MVA difference between 3D PISA method and 2D parasternal plane direct drawing method, which is in good agreement with that obtained by the method of direct delineation of parasternal short axis section. Objective: to investigate the accuracy of three-dimensional proximal isovelocity surface 3D Pi SAA in measuring mitral regurgitation, and to explore the optimal Nyquist velocity limit of using 3D PISA to measure mitral regurgitation (MRV). Methods: 24 patients with mitral regurgitation, including 12 patients with mitral valve prolapse and 8 patients with rheumatic heart disease and 4 patients with functional regurgitation, were selected as subjects. The area of effective mitral regurgitation was measured by two-dimensional proximal isovelocity surface surface 2D Pi SAA and 3D PISA method. The effective mitral regurgitation area calculated by flow difference method was used as a reference for comparison. Results: the effective mitral regurgitation area was measured by using different Nyquist velocity limits of 55 cm / s 10 ~ 3 cm / s ~ 3 cm / s ~ (37) cm / s ~ (28) cm / s ~ (28) cm / s ~ (18) cm / s / s ~ (18) cm / s / s / 3D PISA. When the Nyquist velocity limit increased from 28 cm / s to 28 cm / s, the difference between the effective mitral regurgitation area measured by the method and the reference method was gradually increased. When the selected Nyquist velocity limit is 28 cm / s, the minimum difference between the effective backflow area calculated by the flow difference method and the effective backflow area calculated by the 3D PISA method is 0.06 鹵0.06cm2, and the percentage of the difference is 9 鹵8cm / s between the effective regurgitation area calculated by the flow difference method and the effective regurgitation area calculated by the 3D PISA method and the mitral valvular effectiveness measured by the 2D PISA method and the 3D PISA method. There is a correlation between the area of the regurgitation port and the area of the effective mitral valve regurgitation calculated by the flow difference method. The correlation coefficients were 0.96 and 0.90, respectively. The results of the effective mitral regurgitation area measured by three-dimensional PISA method were in good agreement with the results obtained by the flow difference method. Conclusion: the selected Nyquist velocity limit of 28 cm / s ~ 3 D PISA method is more accurate than 2D PISA method in quantifying mitral regurgitation in patients with mitral regurgitation. Meanwhile, 3D PISA method is easy to operate and may be a new method for evaluating mitral regurgitation flow.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R654.2

【共引文獻(xiàn)】

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