本文選題：高血壓　切入點(diǎn)：心室構(gòu)型　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:利用斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)不同左心室構(gòu)型原發(fā)性高血壓患者左心室心肌縱向、徑向及圓周運(yùn)動(dòng)改變,并探討其臨床意義。方法:按照2005年中國(guó)高血壓防治指南修訂委員會(huì)制定的高血壓診斷及分級(jí)標(biāo)準(zhǔn),選取在2015年11月至2016年3月期間在我院就診的原發(fā)性高血壓患者150例。根據(jù)左心室質(zhì)量指數(shù)和相對(duì)室壁厚度,將其分為3組:左心室構(gòu)型正常組55例,左心室向心性肥厚組53例,左心室離心性肥厚組42例。選取年齡、性別、體重相匹配的50例健康志愿者作為對(duì)照組。采用Philips IE elite彩色多普勒超聲診斷儀,QLAB 9.0工作站中的CMQ插件脫機(jī)分析。對(duì)上述病例組和對(duì)照組進(jìn)行超聲心動(dòng)圖檢查,常規(guī)測(cè)量心臟舒張末期左心室內(nèi)徑、舒張末期室間隔心肌厚度、左心室后壁心肌厚度,應(yīng)用雙平面Simpsons法測(cè)量左室射血分?jǐn)?shù)。在心尖四腔心切面、心尖二腔心切面、左心室長(zhǎng)軸切面及胸骨旁左心室短軸切面采集二維灰介動(dòng)態(tài)圖像。利用斑點(diǎn)追蹤成像技術(shù)在心尖四腔心切面、心尖二腔心切面測(cè)量左心室縱向應(yīng)變、應(yīng)變率;在胸骨旁左心室短軸切面測(cè)量左心室圓周、徑向應(yīng)變、應(yīng)變率。并對(duì)上述結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:3個(gè)高血壓組與正常對(duì)照組比較,高血壓組左心室心肌縱向應(yīng)變及應(yīng)變率較正常對(duì)照均減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),離心性肥厚組縱向心肌應(yīng)變減低更為明顯,且低于向心性肥厚組、左心室構(gòu)型正常組(P0.05);向心性肥厚組和左室構(gòu)型正常組減低程度基本一致,但均低于正常對(duì)照組;離心性肥厚組、向心性肥厚組心肌徑向應(yīng)變、應(yīng)變率較左室構(gòu)型正常組和正常對(duì)照組均減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),離心性肥厚組心肌徑向運(yùn)動(dòng)應(yīng)變、應(yīng)變率較向心性肥厚組減低(P0.05);離心性肥厚組圓周運(yùn)動(dòng)應(yīng)變、應(yīng)變率較向心性肥厚組組、左室構(gòu)型正常組及正常對(duì)照組圓周運(yùn)動(dòng)均減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),向心性肥厚組、左室構(gòu)型正常組及正常對(duì)照組圓周運(yùn)動(dòng)應(yīng)變、應(yīng)變率比較,差異無顯著性意義(P0.05)。離心性肥厚組左心室縱向、徑向及圓周峰值應(yīng)變、應(yīng)變率與向心性肥厚組、左心室構(gòu)型正常組及健康對(duì)照組比較均減低(P0.05);向心性肥厚組左心室縱向、徑向應(yīng)變、應(yīng)變率與左心室構(gòu)型正常組及正常對(duì)照組比較均減低(P0.05);左心室構(gòu)型正常組縱向峰值應(yīng)變、應(yīng)變率與健康對(duì)照組比較減低(P0.05)。結(jié)論:高血壓早期左心室縱向應(yīng)變首先減低,徑向和圓周方向應(yīng)變維持正常,以代償減低的縱向心肌收縮力,左心室縱向應(yīng)變是反映左心室收縮功能早期改變的敏感指標(biāo)。高血壓進(jìn)展期左心室重構(gòu),左心室縱向應(yīng)變、徑向應(yīng)變依次減低,左心室圓周應(yīng)變維持正常。左心室重構(gòu)發(fā)展到離心性肥厚,圓周應(yīng)變最后減低,是高血壓患者維持正常左心室收縮功能的關(guān)鍵指標(biāo)。
[Abstract]:Objective: to evaluate the changes of longitudinal, radial and circular motion of left ventricular myocardium in patients with essential hypertension with different left ventricular configurations by speckle tracking imaging. Methods: according to the criteria of hypertension diagnosis and classification established by the revised Committee of Chinese Hypertension Prevention and treatment in 2005, From November 2015 to March 2016, 150 patients with essential hypertension were selected and divided into three groups according to the left ventricular mass index (LVMI) and the relative wall thickness. 53 cases of left ventricular concentric hypertrophy group and 42 cases of left ventricular eccentric hypertrophy group. 50 healthy volunteers matched with body weight were used as control group. The off-line analysis of CMQ plug-in in Philips IE elite color Doppler ultrasound diagnostic instrument and QLAB9.0 workstation was used. Echocardiography was performed on the above mentioned cases and the control group. The left ventricular ejection fraction (LVEF), left ventricular septal thickness, left ventricular posterior wall thickness and left ventricular ejection fraction (LVEF) were measured by biplane Simpsons method. Two dimensional gray media dynamic images were collected on the long axis section of the left ventricle and the short axis section of the left ventricle adjacent to the sternum. The longitudinal strain and strain rate of the left ventricle were measured on the apical four chamber section and the apical two chamber section by using the speckle tracing imaging technique. The left ventricular circumference, radial strain and strain rate were measured on the short axis of the left ventricle adjacent to the sternum. The longitudinal strain and strain rate of left ventricular myocardium in hypertension group were significantly lower than those in normal control group (P 0.05). The longitudinal myocardial strain in centrifugal hypertrophy group was significantly lower than that in concentric hypertrophy group. The degree of decrease in the concentric hypertrophy group and the left ventricular normal group was basically the same, but lower than that in the normal control group, while in the centrifugal hypertrophy group, the radial strain of the myocardium in the concentric hypertrophy group was lower than that in the eccentric hypertrophy group. The strain rate was lower than that in the normal group and the control group, the difference was statistically significant (P 0.05). The radial motion strain and strain rate of the eccentric hypertrophy group were lower than that of the concentric hypertrophy group (P 0.05), and the peripheral motion strain of the centrifugal hypertrophy group was lower than that of the concentric hypertrophy group. The strain rate was lower than that in the concentric hypertrophy group, the normal left ventricular configuration group and the normal control group, and the difference was statistically significant (P 0.05). The circular motion strain and strain rate of the concentric hypertrophy group, the normal left ventricular configuration group and the normal control group were compared. There was no significant difference between the two groups (P 0.05). The longitudinal, radial and circumferential peak strain, strain rate and strain rate in centrifugal hypertrophy group were significantly lower than those in concentric hypertrophy group, normal left ventricular configuration group and healthy control group (P 0.05), and in concentric hypertrophy group (P 0.05), the left ventricular longitudinal value in concentric hypertrophy group was significantly lower than that in concentric hypertrophy group (P < 0.05). The radial strain and strain rate were lower than those of the normal group and the control group, and the longitudinal peak strain of the normal left ventricular configuration group was significantly lower than that of the normal group. Conclusion: in the early stage of hypertension, the longitudinal strain of left ventricle first decreased, and the radial and circumferential strain remained normal to compensate for the decreased longitudinal myocardial contractility. Left ventricular longitudinal strain is a sensitive index to reflect the early changes of left ventricular systolic function. The left ventricular circumference strain is normal, the left ventricular remodeling develops to eccentric hypertrophy, and the circumferential strain finally decreases, which is the key index to maintain the normal left ventricular systolic function in patients with hypertension.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.11;R445.1

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