發(fā)布時間：2018-06-12 17:40

  本文選題：超聲心動描記術(shù) + 二維��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用斑點追蹤成像(speckle tracking imaging,STI)評價左心室不同構(gòu)型原發(fā)性高血壓患者左心室旋轉(zhuǎn)和扭轉(zhuǎn)運動,得到左心室整體扭轉(zhuǎn)角度和解旋速率,分析原發(fā)性高血壓患者在左心室重構(gòu)過程中心室扭轉(zhuǎn)動力學(xué)變化,并進(jìn)一步探討斑點追蹤成像技術(shù)在評估心功能中的應(yīng)用價值。方法:選取170例原發(fā)性高血壓患者和50例健康志愿者。測量所有受試者收縮壓(SBP)、舒張壓(DBP)和體質(zhì)量指數(shù)(BMI);在胸骨旁左心室長軸切面測量左心室舒張末期內(nèi)徑(LVEDD)、左心室收縮末期內(nèi)徑(LVESD)、室間隔厚度(IVST)和左心室后壁厚度(LVPWT),計算左心室質(zhì)量指數(shù)(LVMI)和相對室壁厚度(RWT);在心尖四腔心切面用脈沖多普勒測量二尖瓣口血流頻譜,包括舒張早期E峰、舒張晚期A峰和減速時間DT,利用組織多普勒測量二尖瓣環(huán)舒張早期運動速度Em和晚期運動速度Am,并計算E/Em;在心尖四腔心和兩腔心切面利用改良Simpson雙平面法測量左心室舒張末期容積(LVEDV),左心室收縮末期容積(LVESV)、左心室每搏量(LVSV)和左心室射血分?jǐn)?shù)(LVEF);在胸骨旁采集一系列左心室短軸二維動態(tài)圖像進(jìn)行存儲,進(jìn)入QLAB工作站進(jìn)行脫機分析,運用STI分別測量左心室短軸切面基底段旋轉(zhuǎn)角度(PBR)、心尖段旋轉(zhuǎn)角度(PAR)、左心室整體扭轉(zhuǎn)角度(Ptw)以及左心室解旋速率(PUV)。結(jié)果:與正常對照組相比,高血壓向心性肥厚(CCH)組與離心性肥厚(ECH)組左心室收縮末期內(nèi)徑和舒張末期內(nèi)徑顯著增加(P0.01),組間比較上述兩項指標(biāo)均有顯著差異(P0.01);與正常對照組比較,高血壓向心性重構(gòu)(CCR)組與向心性肥厚(CCH)組左心室質(zhì)量指數(shù)和相對室壁厚度均顯著增加(P0.01),組間比較上述兩項指標(biāo)無明顯差異(P0.05);與正常對照組相比,高血壓向心性重構(gòu)(CCR)組與向心性肥厚(CCH)組Ptw均增加(P0.01),離心性肥厚(ECH)組Ptw減小(P0.01);與正常對照組相比,向心性重構(gòu)(CCR)組與向心性肥厚(CCH)組PUV增加(P0.01),離心性肥厚(ECH)組PUV較小(P0.05)。結(jié)論:1.高血壓患者左心室發(fā)生向心性重構(gòu)和向心性肥厚時左心室扭轉(zhuǎn)運動代償性加強,解旋速率也相應(yīng)增加;當(dāng)發(fā)生離心性肥厚時左心室扭轉(zhuǎn)減弱,解旋速率也減小。2.STI可以定量分析不同分級、不同構(gòu)型原發(fā)性高血壓患者左心室扭轉(zhuǎn)及解旋運動,可以早期、敏感的反映左心室心肌收縮功能的改變,為預(yù)防和治療心肌損害提供可靠的理論依據(jù),為高血壓患者的療效評價和預(yù)后分析提供了一種新的、無創(chuàng)的、準(zhǔn)確的檢測手段。
[Abstract]:Objective: to evaluate left ventricular rotation and torsion motion in patients with essential hypertension with different left ventricular configurations by speckle tracking imaging with speckle tracking imaging (speckle STI), and to obtain the global left ventricular torsion angle and rotation rate. The dynamic changes of ventricular torsion during left ventricular remodeling in patients with essential hypertension were analyzed and the value of dot-tracing imaging in evaluating cardiac function was discussed. Methods: 170 patients with essential hypertension and 50 healthy volunteers were selected. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) were measured in all subjects. Left ventricular end-diastolic diameter (LVEDDD), left ventricular end-systolic diameter (LVESD), ventricular septal thickness (IVSTT) and left ventricular posterior wall thickness (LVPWTT) were measured on the long axis of left ventricle beside sternum. The left ventricular mass index (LVMI) and relative ventricular wall thickness (RWTT) were calculated. The mitral orifice blood flow spectrum was measured by pulsed Doppler on the apical four-chamber section. Including early diastolic E peak, Late diastolic peak A and deceleration time (DTT), mitral annular diastolic velocities (Em) and late diastolic velocities (Amm) were measured by tissue Doppler, and E / E / E / E / E / E / E / E / E / E / E / E / E / E / E were calculated. Left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), left ventricular volume (LVSVV) and left ventricular ejection fraction (LVVEFV), and left ventricular ejection fraction (LVVEFV) were collected next to the sternum to store a series of dynamic images of the short axis of the left ventricle. After entering Qlab workstation for offline analysis, STI was used to measure left ventricular basal segment rotation angle, apical segment rotation angle, left ventricular global torsion angle and left ventricular unspin rate respectively. Results: compared with the normal control group, the left ventricular end-systolic and end-diastolic diameter were significantly increased in the CCH group and ECH group, and there were significant differences between the two groups. Left ventricular mass index (LVMI) and relative ventricular wall thickness in CCR group and CCH group were significantly increased (P 0.01), but there was no significant difference between the two groups (P 0.05), compared with normal control group, the left ventricular mass index (LVMI) and relative ventricular wall thickness (RVD) in CCR group were significantly higher than those in control group (P < 0.05). Ptw increased in CCR group and CCH group, and decreased in ECH group. Compared with normal control group, PUV increased in CCR group and CCH group, and PUV in ECH group was lower than that in ECH group. The PUV of CCR group and CCH group was higher than that of ECH group, and the PUV of eccentric hypertrophy group was lower than that of normal control group. Conclusion 1. In hypertensive patients, concentric remodeling of the left ventricle and concentric hypertrophy of the left ventricle increased compensatory left ventricular torsion, and the rate of resolution increased correspondingly, and the left ventricular torsion weakened when eccentric hypertrophy occurred. STI can quantitatively analyze the left ventricular torsion and unspin motion in patients with essential hypertension with different configurations, which can reflect the changes of left ventricular systolic function in the early stage. It provides a reliable theoretical basis for the prevention and treatment of myocardial injury, and provides a new, noninvasive and accurate method for the evaluation of curative effect and prognosis of hypertensive patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R544.1

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