本文選題：心室功能 + 右　； 參考：《中國人民解放軍醫(yī)學院》2017年碩士論文

【摘要】：研究背景和目的:左心衰竭是左心室收縮和/或舒張功能嚴重受損的表現(xiàn)和結(jié)果,其診斷和治療始終是臨床的關(guān)注熱點和難點。研究證實左心衰竭患者一旦出現(xiàn)右心功能不全,死亡率和再住院率明顯增高,因此右心功能不全的發(fā)生與否及程度對臨床決策和用藥有重要參考價值。然而目前關(guān)于左心衰竭患者右心功能的研究較少,本研究擬對左室收縮功能減退患者的右室收縮功能進行評估,重點探討左室收縮功能減退發(fā)生右室收縮功能減退的可能影響因素。材料與方法:對128例疑診左心衰竭患者行超聲心動圖檢查,測量左室射血分數(shù)(LVEF),據(jù)入組標準(LVEF50%)最終110例患者(男78例,女32例)診斷為左室收縮功能減退并納入左心衰組,所有患者觀測二尖瓣舒張早、晚期峰值速度(E、A)和組織多普勒二尖瓣環(huán)舒張早期峰值速度(e')并計算E/A、E/e',三尖瓣反流壓差并估測肺動脈收縮壓(PASP)、肺動脈血流加速時間(AT)、左室側(cè)壁達峰時間(LVW TTP)、右室側(cè)壁達峰時間(RVW TTP)并計算差值(LVW-RVW TTP),以及主、肺動脈射血前間期(APEI、PEPT)然后得出二者差值(IVD)。進一步根據(jù)左室收縮功能減低程度、是否伴有肺高壓、是否合并舒張功能減退及是否合并心室間收縮運動失同步將左心衰患者進一步劃分為:輕-中度(35%LVEF50%)和重度(LVEF≤35%),伴肺高壓(PASP≥35mmHg)和不伴肺高壓(PASP35mmHg),合并舒張功能減退(E/e' 14、e' 7)和不合并舒張功能減退(E/e'≤14及e'≥7)以及心室間收縮運動同步(LVW-RVWTTP≤40ms或IVD≤40ms)和心室間收縮運動失同步(LVW-RVW TTP40ms或IVD40ms)等不同亞組。同期選取性別、年齡匹配的65名門診查體健康者(LVEF55%)為對照組。超聲心動圖檢查所有受試者的右心室收縮功能參數(shù):三尖瓣環(huán)收縮期位移(TAPSE)、右心室面積變化率(RVFAC)、三尖瓣環(huán)收縮期峰值速度(S')。比較上述左心衰各亞組與對照組的右心室收縮功能;并分析各亞組主要診斷參數(shù)與右心室收縮功能參數(shù)的相關(guān)性,回歸分析采用曲線擬合法,分析影響因素與右室收縮功能的關(guān)系模型及影響程度。結(jié)果:左心衰組39% (43/110)發(fā)生右室收縮功能不全。各亞組間比較顯示:輕-中度與重度左心衰組的右室收縮功能較對照組均有不同程度減低,且重度左心衰組右室收縮功能減低程度較輕-中度左心衰組加重:TAPSE (16. 9±2. 5 VS18. 5±3.3)mm、RVFAC(38. 1±7. 6VS 45. 1±8.4)%、S' (8. 9±2.3 VS 11.3±3. 5)cm/s(P均0. 05);左心衰伴肺高壓組的右室收縮功能減低程度較不伴肺高壓組減低程度增加:TAPSE(15. 9±1.9 VS 17. 9±2. 9)mm、 RVFAC (35. 9±4. 4 VS42. 3±7. 9)%(P0. 05);左心衰合并舒張功能減退組的右室收縮功能減低程度較不合并舒張功能減退組加重:TAPSE (16. 9 ± 2. 5VS17. 8 ± 3. 1) mm、RVFAC (38. 1 ± 6. 7VS43. 8 ±7. 7)% (P均0.05);左心衰合并左、右心室間收縮運動失同步與心室間收縮運動同步組比較,右室收縮功能的差異無統(tǒng)計學意義(P0. 05)。各亞組主要診斷參數(shù)與右室收縮功能參數(shù)的相關(guān)分析:LVEF與TAPSE、RVFAC、S'呈輕度正相關(guān)(r=0. 327, 0. 405,0.365,P0. 05),PASP 與 TAPSE、RVFAC、S'輕到中度負相關(guān)(r=-0.468, -0.519, -0.443, P0. 01); E/e'與 RVFAC、S'呈輕度負相關(guān)(r=-0. 326, -0. 292, P0. 05) ; LVW-RVW TTP、IVD 與 TAPSE、FAC、S'均無明顯相關(guān)(r=-0.080/-0. 078,-0.028/0.169, -0.073/-0. 015,P0. 05)�；貧w分析顯示:LVEF與TAPSE、RVFAC、S'復合模型擬合最優(yōu)(R2=0. 107、0.164、0.133,P0. 01),方程:y(RVFAC)則=26. 932+1. 11x: PASP 與 TAPSE、RVFAC、S'三次模型擬合最優(yōu)(R2=0. 219、0.269、0.196,P0. 05),方程:y(RVFAC)=32. 226+1. 178x-0. 037x2; E/e'與 RVFAC、S'二次模型擬合最優(yōu)(R2=0. 106、0. 085, P0. 05),方程:y(RVFAC)=48. 076-0. 564x+0. 006x2,以上擬合模型均顯著,提示左室收縮功能減退患者的右室收縮功能減低一定程度上由LVEF、PASP及E/e'的變化所致,影響程度分別為16.4%、26. 9%、10. 6%。結(jié)論:左室收縮功能減退患者存在不同程度的右室收縮功能減退,右室收縮功能減退的發(fā)生和程度與左室收縮功能減退程度、是否合并左心疾病相關(guān)性肺高壓和左室舒張功能減退有關(guān)。
[Abstract]:Background and objective: left heart failure is the performance and results of left ventricular diastolic function and / or severely damaged, the diagnosis and treatment of concern has always been hot and difficult. The clinical study confirmed that patients with left heart failure once right heart dysfunction, mortality and readmission rate was significantly higher, so the function of right heart the incidence of incomplete or not and the degree has important reference value for clinical decision-making and medication. However, on the left heart failure patients with right heart function research, this study on left ventricular systolic function of right ventricular systolic function in patients were assessed, focusing on left ventricular systolic function of right ventricular systolic dysfunction may occur the influence of factors. Materials and methods: 128 patients with suspected heart failure patients with echocardiography, measurement of left ventricular ejection fraction (LVEF), according to the inclusion criteria (LVEF50%) 110 patients (male 78 cases, female 32 cases) Diagnosis of left ventricular systolic function of left heart failure group and included all patients, observation of mitral diastolic early, late peak velocity (E, A) and Doppler tissue mitral annular early diastolic peak velocity (E') and calculate the E/A, E/e', three tricuspid regurgitation pressure and estimation of pulmonary artery systolic pressure (PASP), lung arterial blood flow acceleration time (AT), left ventricular lateral wall peak time (LVW TTP), right ventricular lateral wall peak time (RVW TTP) and calculate the difference (LVW-RVW TTP), and the main pulmonary artery, pre ejection intervals (APEI, PEPT) and the difference between the two (IVD). According to the left ventricular systolic dysfunction, whether with pulmonary hypertension, with diastolic dysfunction and with inter ventricular systolic dyssynchrony in patients with left heart failure will be further divided into: mild to moderate (35%LVEF50%) and severe (LVEF = 35%), patients with pulmonary hypertension (PASP = 35mmHg) and without pulmonary hypertension (PASP35mmHg) and with diastolic function Decreased (E/e'14, E' 7) and not with diastolic dysfunction (E/e'= 14 and E' = 7) and inter ventricular contraction synchronization (LVW-RVWTTP = 40ms or IVD = 40ms) and inter ventricular systolic dyssynchrony (LVW-RVW TTP40ms or IVD40ms) of different sub groups. Selected 65 outpatients in sex. The age-matched healthy persons (LVEF55%) as the control group. Right ventricular systolic function parameters of echocardiography in all subjects: three tricuspid annular systolic displacement (TAPSE), right ventricular fractional area change (RVFAC), three tricuspid annular peak systolic velocity (S'). The comparison of the left heart failure sub group and control group, the right ventricular systolic function; correlation and analysis of the main parameters and diagnostic subgroups of right ventricular systolic function parameters, regression analysis by curve fitting method, analysis of the relationship between the model and the influence factors and the right ventricular systolic function. Results: left heart failure group 39% (43/110). 鐢熷彸瀹ゆ敹緙╁姛鑳戒笉鍏，

本文編號：1770442