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  本文選題：超聲技術(shù)　切入點：維持血液透析　出處：《大連醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的應(yīng)用超聲射頻信號血管內(nèi)中膜分析(QIMT)、血管硬度定量分析（QAS）及心肌應(yīng)變及應(yīng)變率成像分析（XStrain）技術(shù)研究維持性血液透析患者心臟-血管耦聯(lián)(VAC）。 方法選擇在我院維持性血液透析患者70例，按透析過程中有無低血壓的發(fā)生將透析組患者分為透析低血壓組33例和非低血壓組37例，另選取30例身體健康者為對照組，分別接受心臟及血管超聲檢查，獲取頸總動脈內(nèi)中膜厚度（IMT）、僵硬度系數(shù)α、β、脈搏波速度（PWV）、左室射血分數(shù)（LVEF）、左心室間隔厚度（IVST）、心輸出量（CO）、每搏輸出量（SV）、左室收縮末期容積（LVESV），并計算獲得心臟-血管耦聯(lián)指標（VAC）；獲取左心室基底段應(yīng)變（LVSba）、中段應(yīng)變（LVSpm）、心尖段應(yīng)變（LVSap）。 結(jié)果 1.血管超聲 與對照組相比較，透析組血管僵硬度參數(shù)PWV、α、β均增高（P0.05）；透析低血壓組較非低血壓組增高更為顯著（P0.05）。IMT在三組間無統(tǒng)計學差異（P0.05）。 2.心臟超聲 與對照組相比較，透析組LVEF、CO、SV、LVSba、LVSpm、LVSap、VAC減低,IVST增高（P0.05）；透析低血壓組LVEF、CO、SV、LVSba、LVSpm、LVSap、VAC明顯低于非低血壓組（P0.05）；IVST在透析兩組間無統(tǒng)計學差異（P0.05）。LVESV在三組間無統(tǒng)計學差異（P0.05）。 3.相關(guān)分析 PWV、β、LVSap與VAC呈正相關(guān)（P0.01）。進一步多元線性回歸分析，LVSap、β、PWV為VAC獨立相關(guān)的變量，，標準回歸系數(shù)分別為0.599、0.113、0.237. 結(jié)論 1.維持性血液透析患者血管彈性減低早于血管結(jié)構(gòu)的變化。QIMT及QAS技術(shù)檢測的血管彈性參數(shù)β、PWV是反映動脈彈性功能的敏感指標。 2.維持性血液透析患者左室局部收縮功能減低早于左室整體功能的改變。心肌應(yīng)變及應(yīng)變率成像分析（XStrain）技術(shù)檢測的左室心肌應(yīng)變是早期反映左室收縮功能改變的敏感指標。 3.維持性血液透析患者心臟血管失耦聯(lián)，透析低血壓者程度加重。左室心尖部心肌應(yīng)變（LVSap）是評價維持性血液透析患者心臟-血管耦聯(lián)的敏感指標。血管內(nèi)中膜分析(QIMT)、血管硬度定量分析（QAS）及心肌應(yīng)變及應(yīng)變率成像分析（XStrain）技術(shù)可用于對維持性血液透析患者心臟血管耦聯(lián)關(guān)系的評價，為臨床早期診斷及治療提供參考。
[Abstract]:Objective to study the cardio-vascular coupling of maintenance hemodialysis patients using ultrasound radiofrequency signal endovascular media analysis (QIMT), quantitative analysis of vascular hardness (QASs) and myocardial strain and strain rate imaging (strain-rate imaging) technique. Methods 70 patients with maintenance hemodialysis in our hospital were selected. According to the occurrence of hypotension during dialysis, the hemodialysis group was divided into three groups: 33 patients in the hemodialysis group and 37 patients in the non-hypotension group, and 30 healthy persons were selected as the control group. The heart and blood vessels were examined by ultrasound respectively. The common carotid artery intima media thickness (IMT), stiffness coefficient 偽, 尾, pulse wave velocity and PWVV, left ventricular ejection fraction (LVEF), left ventricular septal thickness (LVSET), cardiac output (VT), ventricular output volume (SVN), left ventricular end-systolic volume (LVESVV) were obtained, and cardio-vascular coupling was calculated. The left ventricular basal segment strain (LVSBA), the middle segment strain (LVSpmN), the apical segment strain (LVSapa), the left ventricular basal segment strain (LVSBA), the middle segment strain (LVSpmN) and the apical segment strain were obtained. Results. 1. Vascular ultrasound. Compared with the control group, the blood vessel stiffness parameters PWV, 偽, 尾 in the dialysis group were significantly higher than those in the non-hypotension group (P 0.05), and there was no significant difference between the three groups in the blood vessel stiffness (PWV), 偽 and 尾 (P 0.05). 2. Echocardiography. Compared with the control group, the LVSBA LVSapVAC of LVEF CoSVP / LVSapVAC in dialysis group was lower than that of control group (P 0.05), and that of LVEF CoSVSVLVSban LVSBA LVSapsil VAC in dialysis group was significantly lower than that of non-hypotension group (P0.05IVST). There was no significant difference in LVSapVAC between the three groups (P 0.05N. LVESV). 3. Related analysis. There was a positive correlation between VAC and VAC, and further multivariate linear regression analysis showed that VAC was an independent correlation variable, and the standard regression coefficient was 0.599 / 0.113 / 0.237, respectively. Conclusion. 1. The decrease of vascular elasticity in maintenance hemodialysis patients was earlier than the change of vascular structure. QIMT and QAS were sensitive indexes to reflect the elastic function of artery. 2. The regional systolic function of the left ventricle decreased earlier than that of the whole left ventricular function in the patients with maintenance hemodialysis, and the strain and strain rate imaging technique was used to detect the left ventricular myocardial strain, which was a sensitive index to reflect the change of the left ventricular systolic function in the early stage. 3. Cardiac vascular decoupling in patients with maintenance hemodialysis, Left ventricular apical myocardial strain (LVSapa) is a sensitive index for evaluating cardio-vascular coupling in maintenance hemodialysis patients. VAR analysis can be used to evaluate the cardiac vascular coupling in maintenance hemodialysis patients. To provide reference for early clinical diagnosis and treatment.
【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】：2014
【分類號】：R445.1;R459.5

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