本文選題：室性早搏 + 超聲心動(dòng)描記術(shù)��； 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：背景及目的：室性早搏,亦稱室性期前收縮(Premature Ventricular Complexes,PVCs)是臨床上常見的心律失常,近年來研究表明頻發(fā)室性早搏可能導(dǎo)致心功能惡化,可造成室性早搏介導(dǎo)的心肌病。既往傳統(tǒng)方法并不能有效評(píng)估頻發(fā)室性早搏患者早期心功能損害情況,實(shí)時(shí)三維超聲斑點(diǎn)追蹤技術(shù)(3D-STI)提供了一種新的簡(jiǎn)便無創(chuàng)的定量評(píng)價(jià)心功能的方法,本研究旨在應(yīng)用3D-STI技術(shù)定量評(píng)價(jià)頻發(fā)室性早搏患者心功能損害情況,對(duì)此類患者心功能的早期評(píng)估、臨床治療及長(zhǎng)期隨訪提供指導(dǎo)。方法：1.收集2013年7月至2014年3月于我院住院的頻發(fā)室性早搏患者40人(男性22例),連續(xù)24小時(shí)動(dòng)態(tài)心電圖記錄室性早搏數(shù)量超過10000次,呈單源性室性早搏,所有病人常規(guī)體格檢查未見異常,排除器質(zhì)性心臟病。另選取健康志愿者40人(男性24例)作為正常對(duì)照組。2.受試者均行常規(guī)標(biāo)準(zhǔn)12導(dǎo)聯(lián)心電圖,記錄正常QRS波形態(tài)、時(shí)限及室性早搏的形態(tài)、時(shí)限,動(dòng)態(tài)心電圖評(píng)估室性早搏負(fù)荷(PVC burden)。3.受試者均行常規(guī)二維超聲心動(dòng)圖檢查：常規(guī)檢查切面觀包括胸骨旁長(zhǎng)軸觀,胸骨旁短軸觀(主動(dòng)脈根部、二尖瓣水平、乳頭肌水平、心尖水平),心尖位(四腔觀、五腔觀、二腔觀、長(zhǎng)軸觀)；普通心臟M型超聲檢查測(cè)量主動(dòng)脈根部?jī)?nèi)徑、左房?jī)?nèi)徑、左室舒張末期內(nèi)徑、左室收縮末期內(nèi)徑、室間隔厚度、左室后壁厚度；測(cè)量左室舒張末期和收縮末期容量并計(jì)算左室射血分?jǐn)?shù)。4.受試者均行實(shí)時(shí)三維超聲斑點(diǎn)追蹤成像技術(shù)檢查：探頭置于心尖部,在顯示心尖四腔心切而后切換至4D模式,采集實(shí)時(shí)全容積成像三維圖像。脫機(jī)計(jì)算芹室整體縱向收縮峰值應(yīng)變(GLS)、整體徑向收縮峰值應(yīng)變(GRS)、整體環(huán)向收縮峰值應(yīng)變(GCS)、整體面積收縮峰值應(yīng)變(GAS)及各節(jié)段應(yīng)變值等數(shù)值,分析應(yīng)變值對(duì)頻發(fā)室性早搏患者心功能損害的診斷價(jià)值。結(jié)果：1.頻發(fā)室性早搏組與正常對(duì)照組臨床特點(diǎn)等基線具有可比性,年齡、性別、體表面積等比較未見明顯差異(P0.05)。2.頻發(fā)室性早搏組與正常對(duì)照組常規(guī)二維超聲心動(dòng)圖檢查：主動(dòng)脈根部?jī)?nèi)徑、左房?jī)?nèi)徑、左室舒張末期內(nèi)徑、左室收縮末期內(nèi)徑、室間隔厚度、左室后壁厚度、左室射血分?jǐn)?shù)等指標(biāo)比較未見明顯差異(P0.05)。3.頻發(fā)室性早搏組與正常對(duì)照組三維超聲斑點(diǎn)追蹤成像技術(shù)(3D-STI)檢查比較：左室整體縱向收縮峰值應(yīng)變(GLS)(-13.50±3.00%vs-18.31±3.12%, P=0.001)、左室整體環(huán)向收縮峰值應(yīng)變(GCS)(-13.21±4.52%vs-19.49±2.60%, P=0.001)、左室整體面積收縮峰值應(yīng)變(GAS)(-22.43±5.02%vs-29.86±4.81％, P=0.001)及左室整體徑向收縮峰值應(yīng)變(GRS)(36.31±8.81%vs 49.61±10.12%, P=0.001),頻發(fā)室性早搏組較正常對(duì)照組各整體應(yīng)變值均明顯減低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.頻發(fā)室性早搏組與正常對(duì)照組左室基底段、中間段及心尖段的縱向應(yīng)變(LS)、環(huán)向應(yīng)變(CS)、面積應(yīng)變(AS)及徑向應(yīng)變(RS)值相比均明顯減低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.室性早搏負(fù)荷20%的患者與室性早搏負(fù)荷≥20%的患者的左室舒張末期容積、左室收縮末期容積、左室射血分?jǐn)?shù)、GLS、GCS、GAS及GRS值比較,各指標(biāo)未見顯著差異(P0.05)。6.GLS、GCS、GAS、GRS與左室射血分?jǐn)?shù)(LVEF)有良好的相關(guān)性,其中6CS與LVEF的相關(guān)性最好(r=-0.84,P=0.020)；各應(yīng)變值觀察者內(nèi)及觀察者間呈一致性的變化趨勢(shì),有著很好的重復(fù)性。結(jié)論：1.左室射血分?jǐn)?shù)正常的頻發(fā)室性早搏患者較正常對(duì)照組左室整體及節(jié)段三維應(yīng)變值(縱向應(yīng)變、徑向應(yīng)變、環(huán)向應(yīng)變及面積應(yīng)變)均減低。2.三維超聲斑點(diǎn)追蹤技術(shù)可敏感精確評(píng)價(jià)頻發(fā)室性早搏患者隱匿性心功能損害情況。3.三維斑點(diǎn)追蹤技術(shù)為定量評(píng)價(jià)左室功能提供了一種可行性高、重復(fù)性好、無創(chuàng)安全、簡(jiǎn)便有效的新方法。
[Abstract]:Background and purpose: ventricular premature beat, also known as Premature Ventricular Complexes (PVCs), is a clinically common arrhythmia. In recent years, studies have shown that frequent ventricular premature beats may cause cardiac deterioration and cause ventricular premature cardiac myopathy. Previous traditional methods do not effectively evaluate frequent ventricular premature beat patients. Early cardiac dysfunction, real-time three-dimensional ultrasound speckle tracking (3D-STI) provides a new and simple and noninvasive method for quantitative evaluation of cardiac function. This study aims to evaluate the cardiac function of patients with frequent ventricular premature beat by 3D-STI technique. Early assessment, clinical treatment and long-term follow-up of cardiac function in such patients. Methods: 1.. Methods: 40 patients with frequent ventricular premature beat (22 men) were collected from July 2013 to March 2014 in our hospital. The number of ventricular premature beats was more than 10000 times for 24 hours of ambulatory electrocardiogram (24 hour). 40 people (24 men) as the normal control group,.2. subjects all underwent routine standard 12 lead electrocardiogram, recorded normal QRS wave form, time limit and ventricular premature beat, time limit, and dynamic electrocardiogram assessment of ventricular premature beat load (PVC burden).3. subjects all performed routine Er Weichao echocardiography examination: routine examination of side view including parastenal length Axis view, short axis view beside the sternum (aortic root, mitral valve level, papillary muscle level, apical level), apical position (four cavities, five cavities, two cavities, long axis); common heart M ultrasound examination of the aortic root diameter, left atrium diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, interventricular septum thickness and left posterior wall thickness; The patients who measured left ventricular end diastolic and end systolic volume and calculated left ventricular ejection fraction.4. were examined by real time three-dimensional ultrasound speckle tracking imaging technique: the probe was placed in the apex of the apex, and the four cavity of the apex was displayed and then switched to the 4D mode, and the real time full volume imaging three-dimensional image was collected. The value of change (GLS), total radial contraction peak strain (GRS), overall circumferential peak strain (GCS), total area contraction peak strain (GAS) and each segment strain value were used to analyze the diagnostic value of strain value on cardiac dysfunction in patients with frequent ventricular premature beat. Results: the baseline of the clinical characteristics of 1. frequent ventricular premature beat group and normal control group Comparability, age, sex, and body surface area were not significantly different (P0.05).2. frequent ventricular premature beat group and normal control group routine two-dimensional echocardiography examination: aortic root diameter, left atrium diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular ejection fraction and other index ratio No significant difference (P0.05).3. frequent ventricular premature beat group and normal control group three-dimensional ultrasound speckle tracking imaging (3D-STI) examination: left ventricular overall longitudinal contraction peak strain (GLS) (-13.50 + 3.00%vs-18.31 + 3.12%, P=0.001), left ventricular holistic circumferential peak strain (GCS) (-13.21 + 4.52%vs-19.49 + 2.60%, P=0.001), left ventricle, left ventricle The overall area systolic peak strain (GAS) (-22.43 + 5.02%vs-29.86 + 4.81%, P=0.001) and the overall left ventricular radial systolic peak strain (GRS) (36.31 + 8.81%vs 49.61 + 10.12%, P=0.001), the frequency of frequent ventricular premature beat groups were significantly lower than those of the normal control group, and the difference was statistically significant (P0.05) in the.4. frequent ventricular premature beat group and positive group. The longitudinal strain (LS), CS, area strain (AS) and radial strain (RS) were significantly lower in the left ventricular base segment, the middle segment and the apical segment, and the difference was statistically significant (P0.05).5. ventricular premature beat 20% patients and the left ventricular end diastolic volume and left ventricular end systolic volume in patients with ventricular premature beat more than 20% No significant difference (P0.05).6.GLS, GCS, GAS, GRS and left ventricular ejection fraction (LVEF) were not significantly different between the scores of left ventricular ejection fraction, GLS, GCS, GAS and GRS. The correlation between 6CS and LVEF was the best, and the trend of consistency between the observers and the observers was good. Conclusion: 1. the three dimensional strain values (longitudinal strain, radial strain, circumferential strain, and area strain) in the left ventricular global and segmental strain of normal ventricular premature beat patients with normal left ventricular ejection fraction are more sensitive and accurate in evaluating the occult cardiac function damage in patients with frequent ventricular premature beat.3. three dimensional (.2.). Speckle tracking technique provides a feasible, reproducible, noninvasive, safe, simple and effective method for quantitative evaluation of left ventricular function.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541.7;R540.45

【共引文獻(xiàn)】

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8 楊楊;應(yīng)用斑點(diǎn)追蹤技術(shù)評(píng)價(jià)擴(kuò)張型心肌病患者左室心肌應(yīng)變及扭轉(zhuǎn)運(yùn)動(dòng)[D];揚(yáng)州大學(xué);2014年

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10 王黎紅;右室流出道特發(fā)性室性早搏射頻消融靶點(diǎn)虛擬單極電圖的特征分析[D];南昌大學(xué);2014年

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