本文選題：超聲心動描記術　切入點：主動脈根部　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:測量主動脈直徑對診斷和監(jiān)測主動脈疾病具有重要意義,但至目前關于主動脈直徑的測量尚沒有統(tǒng)一的標準。本文旨在應用二維超聲心動圖采用內緣-內緣方法研究健康成人主動脈根部(Aorta root,AoR)直徑參考值及其隨年齡、性別及體表面積(body surface area,BSA)改變的變化規(guī)律。方法:選取太鋼總醫(yī)院體檢中心和門診健康成人306例,既往無心血管病、高血壓、糖尿病、瓣膜及先天性心臟病、主動脈二瓣化、心力衰竭、心肌病、竇性心動過速、內分泌系統(tǒng)疾病、妊娠及使用違禁藥物史,經實驗室、心電圖、X線胸片及常規(guī)超聲心動圖檢查無異常;BMI28kg/m2;5例因圖像質量差不能清晰顯示主動脈長軸而被剔除(胸廓畸形和肋間隙狹窄等原因造成),余301例(年齡45.8±15.8歲,男146例,女155例)納入本研究,依性別分兩組,按年齡分五組,并通過太鋼總醫(yī)院倫理委員會的批準,同時得到所有受試者的知情同意。采用美國GE的VividE9彩色多普勒超聲診斷儀,配置M5S-D二維探頭(頻率1.5-4.5MHz)對所有研究對象行標準二維超聲心動圖檢查,于胸骨旁主動脈長軸采用內緣-內緣的方法測量AoR直徑,除瓣環(huán)(aortic annulus,AoA)于收縮中期測量外,竇部(the sinuses of Valsalva,AoS)、竇管連接部(the sinotubular junction,AoST)及升主動脈近端(the proximal ascending aorta,AAo)于舒張末期測量,確保測量線垂直于主動脈長軸。數(shù)據(jù)采集由兩位具有五年以上工作經歷的醫(yī)師完成,測量數(shù)據(jù)由其中一位醫(yī)師完成。同步記錄心電圖,連續(xù)采集五個心動周期,并采用心電圖確定測量時間點。M型超聲于左室長軸水平測量舒張期和收縮期左室內徑、室間隔和左室后壁厚度。采用多普勒血流顯像評估心臟四個瓣膜的有無返流及返流程度,采集標準的心尖四腔、兩腔、三腔切面,儲存于機內。采用非配對t檢驗分析不同性別間的差異;多元回歸分析年齡、性別、體表面積、身高及體重對主動脈直徑的影響;隨機抽取30例研究對象,采用Person相關和Bland-Altman法進行重復性檢驗,分析觀察者內及觀察者之間測量的一致性;以p0.05認為有統(tǒng)計學意義。結果:AoA、AoS、AoST及AAo近端的95%上界值各為男性:20.93mm,33.02mm,28.50mm和30.67mm;女性:19.12mm,30.72mm,27.72mm和30.50mm。隨年齡增長,除AoA外,AoS、AoST及AAo近端直徑均有增大趨勢,男性大于女性(P0.01)。BSA標化后,AoA與年齡無相關性;AoS、AoST及AAo近端與年齡有相關性(r=0.254、0.411和0.511,均P0.001);標化后男性AoST及AAo近端小于女性(P=0.01、0.001),而AoA和AoS性別間無差異。多元回歸分析AoR與年齡、性別及BSA有相關性,R2為0.19-0.33,AoA與年齡無顯著相關(β=-0.007,P=0.89),身高、體重對AoR直徑無額外影響。Person相關和Blant-Altman法分析觀察者內和觀察者間的差異:觀察者內AoA r=0.84,AoS r=0.85,AoST r=0.84,AAo r=0.87,一致性檢驗:AoA 0.5±2.35mm,AoS 0.5±2.35mm,AoST 0.6±3.35mm,AAo 0.1±2.8mm;觀察者間AoA r=0.87,AoS r=0.79,AoST r=0.81,AAo r=0.77,一致性檢驗:AoA 1.2±2.1mm,AoS 0.6±2.1mm,AoST 0.6±3.7mm,AAo 1.0±4.8mm。結論:初步建立了健康成人內緣-內緣方法學測量AoR直徑的正常參考值范圍,探討了主動脈AoS、AoST及AAo近端直徑隨年齡增長有增大趨勢的變化規(guī)律,這可能為主動脈結構和血流動力學研究以及對AoR疾病的臨床診斷、療效評價和預后判斷提供了重要參考依據(jù)。
[Abstract]:Objective: to measure the diameter of the aorta is of great significance to the diagnosis and monitoring of aortic disease, but to the measurement of the aortic diameter there is no unified standards. This paper aimed at the application of two-dimensional echocardiography on aortic root using healthy adult inner - Inner method (Aorta root AoR) and the diameter of the reference value with age, sex and body surface area (body surface area, BSA) changing rules. Methods: healthy adult Taigang general hospital medical center and clinic in 306 cases, no previous history of cardiovascular disease, hypertension, diabetes mellitus, valvular and congenital heart disease, aortic valve two, cardiomyopathy, heart failure, sinus tachycardia, endocrine system diseases, pregnancy and use drug history, laboratory, electrocardiogram, chest X-ray and echocardiography examination no abnormalities; BMI28kg/m2; 5 cases due to poor image quality can clearly display the aortic long axis Was rejected (caused by thoracic deformity and narrow intercostal space and other reasons), more than 301 cases (age 45.8 + 15.8 years old, male 146 cases, female 155 cases) were included in this study, according to sex were divided into two groups, divided into five groups according to age, and by Taigang General Hospital ethics committee approval, and informed consent all of the subjects. Using the GE VividE9 color Doppler ultrasonic diagnostic apparatus, configuration of two-dimensional M5S-D probe (frequency 1.5-4.5MHz) all subjects underwent standard two-dimensional echocardiography in the parasternal long axis of aorta by means of Inner - inner diameter measurement AoR, except the valve ring (aortic annulus, AoA) on the contraction interim survey, antrum (the sinuses of Valsalva, AoS), sinus pipe junction (the sinotubular, junction, AoST) and the proximal ascending aorta (the proximal ascending aorta, AAo) in diastolic measurements, ensure the measuring line perpendicular to the long axis of aorta by data acquisition. Two more than five years working experience of the surgeon, the measurement data by one surgeon. ECG, continuous acquisition of five cardiac cycles, and determine the measurement time point.M ultrasonic level measurement in left ventricular diastolic and systolic left ventricular diameter by ECG, ventricular septum and left ventricular posterior wall thickness. Using the Doppler flow imaging assessment of cardiac valve four has no reflux and reflux, collecting standard apical four chamber, two chamber, three chamber view, stored in the machine. Using non paired t test analysis of differences between genders; multiple regression analysis, age, gender, height and body surface area, influence the weight of aortic diameter; 30 patients were randomly selected for the research object, repetition test by using Person and Bland-Altman method, the consistency between the observer and the observer analysis; P0.05 was considered statistically significant Results: AoA, AoS, AoST and AAo 95% upper bound of the proximal end of the value of each male: 20.93mm, 33.02mm, 28.50mm and 30.67mm; 19.12mm, 30.72mm, 27.72mm: women and 30.50mm. with age, except AoA, AoS, AoST and AAo proximal diameter were increasing trend, male more than female (P0.01.BSA) after standardization, there is no correlation between AoA and AoS, AoST and AAo age; the proximal end was correlated with age (r=0.254,0.411 and 0.511, P0.001); standardized male AoST and proximal AAo lower than that of the female (P=0.01,0.001), while AoA and AoS had no difference between gender. Multiple AoR regression analysis with age, gender relationship and BSA, R2 for 0.19-0.33, no significant correlation of AoA with age (beta =-0.007, P=0.89), height, weight and no additional influence on the AoR diameter of the intra observer and.Person correlation and Blant-Altman method between the intra observer differences: AoA r=0.84, AoS R =0.85, AoST r=0.84, AAo r=0.87, consistency test AoA: 0.5 + 2. 35mm, AoS AoST 0.5 + 2.35mm, 0.6 + 3.35mm, 0.1 + AAo 2.8mm; inter observer AoA r=0.87, AoS r=0.79, AoST r=0.81, AAo r=0.77, consistency test: AoA 1.2 + 2.1mm AoS 0.6 + 2.1mm, 0.6 + AoST 3.7mm AAo + 4.8mm., 1 conclusions: the initial establishment of a healthy adult inner - the normal reference measurement method of inner diameter AoR value range of AoS, AoST and AAo in aorta and proximal diameter changes with age increasing, the possibility to research the structure and hemodynamics of aorta and the clinical diagnosis of AoR disease, and provides an important reference for the efficacy evaluation and prognosis.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R540.45

【參考文獻】

相關期刊論文 前1條

1 楊光釗，，凌美玲，沈天真，陳星榮，詹松華，李森華;正常胸主動脈內徑磁共振成像測量[J];中國循環(huán)雜志;1994年01期

本文編號：1600402