實時三維斑點追蹤技術(shù)評價缺血及再灌注后犬頓抑心肌左室收縮功能
發(fā)布時間：2018-08-02 08:41
【摘要】：目的 本研究應(yīng)用實時三維斑點追蹤顯像技術(shù)，通過建立缺血再灌注后犬頓抑心肌模型，從局部和整體等方面對左室收縮功能進行評價，明確缺血再灌注后頓抑心肌的結(jié)構(gòu)及功能變化，從而為臨床早期、無創(chuàng)冠心病心絞痛診斷提供新的思路。 方法 結(jié)扎9只成年雜種犬左冠狀動脈前降支，15min后行再灌注，分別于缺血前、缺血5min、缺血15min、再灌注30min、60min、90min及120min采集心尖切面三維圖像及二維圖像，應(yīng)用雙平面Simpson's法在心尖兩腔心切面及四腔心切面測量常規(guī)指標(biāo)：左室舒張末期容積(LVEDV)、左室收縮末期容積(LVESV)、左室舒張末期內(nèi)徑(LVDD)、左室收縮末期內(nèi)徑(LVDS)、左室射血分?jǐn)?shù)(LVEF)。應(yīng)用實時三維斑點追蹤顯像技術(shù)檢測缺血(前基底、前中部、隔前基底及隔前中部)及非缺血(后基底及后中部)心肌節(jié)段縱向、徑向、圓周及面積峰值應(yīng)變（LSpeak、RSpeak、CSpeak、ASpeak），整體峰值應(yīng)變（GLSpeak、GRSpeak、GCSpeak、GASpeak）,并分析整體峰值應(yīng)變與LVEF相關(guān)性，從而評價左室局部及整體收縮功能。 結(jié)果 1、犬缺血及再灌注后左室常規(guī)超聲指標(biāo)比較：LVESV、LVEDV、LVDS、LVDD在缺血期間均增大，與缺血前相比差異有統(tǒng)計學(xué)意義（P＜0.05）；LVEF在缺血期間減低，與缺血前相比差異有統(tǒng)計學(xué)意義（P＜0.05）。再灌注后30min恢復(fù)正常，與缺血前相比差異無統(tǒng)計學(xué)意義（P＞0.05）。 2、實時三維斑點追蹤技術(shù)測量左室整體收縮功能比較：與缺血前相比，，缺血期間左室各整體應(yīng)變參數(shù)均減低，差異有統(tǒng)計學(xué)意義（P＜0.05）。隨再灌注時間延長逐漸恢復(fù)， GASpeak恢復(fù)時間最長（120min），與缺血前相比差異無統(tǒng)計學(xué)意義（P＞0.05）。實時三維斑點追蹤顯像技術(shù)測量缺血前后各時點各整體應(yīng)變參數(shù)均與LVEF呈正相關(guān)，其中以GASpeak與LVEF的相關(guān)性最高。 3、實時三維斑點追蹤技術(shù)測量左室局部收縮功能比較：缺血心肌Speak的變化：與缺血前相比，缺血期間缺血節(jié)段各應(yīng)變指標(biāo)均降低，差異有統(tǒng)計學(xué)意義（P＜0.05），應(yīng)變逐漸恢復(fù)正常（隨再灌注時間延長），但直至120min時仍未達到正常，與缺血前相比差異有統(tǒng)計學(xué)意義（P＜0.01）。非缺血心肌Speak的變化：與缺血前相比，缺血期間非缺血節(jié)段各應(yīng)變指標(biāo)均升高，差異有統(tǒng)計學(xué)意義（P＜0.05），于再灌注30min均恢復(fù)正常，與缺血前相比差異無統(tǒng)計學(xué)意義（P＞0.05）。 結(jié)論 1、常規(guī)超聲檢查僅可以檢測出缺血期間左室整體收縮功能減低的情況，而實時三維斑點追蹤顯像技術(shù)對左室局部心肌頓抑現(xiàn)象的評價有較大的應(yīng)用價值。 2、缺血再灌注后犬左室心肌整體收縮功能延遲恢復(fù)，即存在心肌頓抑現(xiàn)象。 3、缺血再灌注后犬左室心肌局部收縮功能延遲恢復(fù)，且與整體功能相比，局部功能恢復(fù)時間更長。 4、實時三維斑點追蹤顯像技術(shù)指標(biāo)中，面積應(yīng)變指標(biāo)最為敏感，有望成為早期診斷冠心病心絞痛的新指標(biāo)。
[Abstract]:Objective to evaluate the left ventricular systolic function by establishing a canine model of myocardial arrest after ischemia reperfusion using real time 3D speckle tracing imaging. The changes of myocardial structure and function after ischemia reperfusion were determined, which provided a new idea for the early diagnosis of angina pectoris of non-invasive coronary heart disease. Methods the left anterior descending coronary artery of 9 adult mongrel dogs was ligated for 15 minutes and then reperfused. Before ischemia, 5 minutes of ischemia, 15 minutes of ischemia, 30 minutes of reperfusion, 60 minutes or 90 minutes of reperfusion, and 120min, 3D and 2D images of the apex were collected. Biplane Simpson's method was used to measure the normal indexes of the apical two chamber incisor and four chamber section: left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVDS), left ventricular ejection fraction (LVEF).; left ventricular end-diastolic volume; left ventricular end-systolic dimension; left ventricular ejection fraction (LVEF).; left ventricular end-systolic dimension (LVDS), left ventricular ejection fraction (LVEF). The longitudinal and radial segments of ischemic (anterior basal, middle septal, anterior septal and middle septal) and non-ischemic (posterior and posterior middle) myocardial segments were detected by real-time 3D speckle tracing imaging. The peak circumference and area strain (LSpeak-RSpeak-CSpeak-ASpeak) and the global peak strain (GLSpeak-GRCSpeak-GCSpeak-GASpeak) were analyzed, and the correlation between the global peak strain and LVEF was analyzed to evaluate the local and global systolic function of left ventricle. Results 1. Compared with the normal ultrasound indexes of left ventricle after ischemia and reperfusion in dogs, the LVDD of LVDS / LVDD increased significantly during ischemia (P < 0.05), and the LVEF decreased during ischemic period (P < 0.05), and the LVDD of LVDS / LVDD in LVESVV / LVEDVV / LVDS / LVDD / LVDD was significantly lower than that before ischemia (P < 0.05). The difference was statistically significant compared with that before ischemia (P < 0.05). 30min returned to normal after reperfusion (P > 0. 05). 2. Real-time 3D speckle tracing technique was used to measure the global systolic function of left ventricle. The global strain parameters of the left ventricle decreased during ischemia (P < 0.05). With the prolongation of reperfusion time, the recovery time of GASpeak was the longest (120min), which had no significant difference compared with that before ischemia (P > 0. 05). Real time 3D speckle tracing imaging was used to measure the global strain parameters at different time points before and after ischemia, which was positively correlated with LVEF. Among them, the correlation between GASpeak and LVEF was the highest. 3. Real time 3D speckle tracing technique was used to measure the left ventricular regional systolic function. The changes of Speak in ischemic myocardium were compared with those before ischemia. The difference was statistically significant (P < 0. 05), the strain gradually returned to normal (with the time of reperfusion), but still did not reach normal until the time of 120min (P < 0. 01) compared with that before ischemia (P < 0. 01). Changes of Speak in non-ischemic myocardium: compared with those before ischemia, all the strain indexes of non-ischemic segments increased during ischemia (P < 0. 05), but 30min returned to normal after reperfusion, but there was no significant difference compared with that before ischemia (P > 0. 05). Conclusion 1. Conventional ultrasound can only detect the decrease of global left ventricular systolic function during ischemia. Real-time 3D speckle tracing imaging is of great value in evaluating left ventricular regional myocardial arrest. 2. The global systolic function of left ventricle is delayed after ischemia reperfusion in dogs. There was myocardial depression. 3. The regional systolic function of left ventricle was delayed after ischemia reperfusion in dogs, and compared with the global function. The recovery time of local function is longer. 4. Among the technical indexes of real-time 3D speckle tracing imaging, the area strain index is the most sensitive one, which is expected to be a new index for early diagnosis of angina pectoris of coronary heart disease.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1
[Abstract]:Objective to evaluate the left ventricular systolic function by establishing a canine model of myocardial arrest after ischemia reperfusion using real time 3D speckle tracing imaging. The changes of myocardial structure and function after ischemia reperfusion were determined, which provided a new idea for the early diagnosis of angina pectoris of non-invasive coronary heart disease. Methods the left anterior descending coronary artery of 9 adult mongrel dogs was ligated for 15 minutes and then reperfused. Before ischemia, 5 minutes of ischemia, 15 minutes of ischemia, 30 minutes of reperfusion, 60 minutes or 90 minutes of reperfusion, and 120min, 3D and 2D images of the apex were collected. Biplane Simpson's method was used to measure the normal indexes of the apical two chamber incisor and four chamber section: left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVDS), left ventricular ejection fraction (LVEF).; left ventricular end-diastolic volume; left ventricular end-systolic dimension; left ventricular ejection fraction (LVEF).; left ventricular end-systolic dimension (LVDS), left ventricular ejection fraction (LVEF). The longitudinal and radial segments of ischemic (anterior basal, middle septal, anterior septal and middle septal) and non-ischemic (posterior and posterior middle) myocardial segments were detected by real-time 3D speckle tracing imaging. The peak circumference and area strain (LSpeak-RSpeak-CSpeak-ASpeak) and the global peak strain (GLSpeak-GRCSpeak-GCSpeak-GASpeak) were analyzed, and the correlation between the global peak strain and LVEF was analyzed to evaluate the local and global systolic function of left ventricle. Results 1. Compared with the normal ultrasound indexes of left ventricle after ischemia and reperfusion in dogs, the LVDD of LVDS / LVDD increased significantly during ischemia (P < 0.05), and the LVEF decreased during ischemic period (P < 0.05), and the LVDD of LVDS / LVDD in LVESVV / LVEDVV / LVDS / LVDD / LVDD was significantly lower than that before ischemia (P < 0.05). The difference was statistically significant compared with that before ischemia (P < 0.05). 30min returned to normal after reperfusion (P > 0. 05). 2. Real-time 3D speckle tracing technique was used to measure the global systolic function of left ventricle. The global strain parameters of the left ventricle decreased during ischemia (P < 0.05). With the prolongation of reperfusion time, the recovery time of GASpeak was the longest (120min), which had no significant difference compared with that before ischemia (P > 0. 05). Real time 3D speckle tracing imaging was used to measure the global strain parameters at different time points before and after ischemia, which was positively correlated with LVEF. Among them, the correlation between GASpeak and LVEF was the highest. 3. Real time 3D speckle tracing technique was used to measure the left ventricular regional systolic function. The changes of Speak in ischemic myocardium were compared with those before ischemia. The difference was statistically significant (P < 0. 05), the strain gradually returned to normal (with the time of reperfusion), but still did not reach normal until the time of 120min (P < 0. 01) compared with that before ischemia (P < 0. 01). Changes of Speak in non-ischemic myocardium: compared with those before ischemia, all the strain indexes of non-ischemic segments increased during ischemia (P < 0. 05), but 30min returned to normal after reperfusion, but there was no significant difference compared with that before ischemia (P > 0. 05). Conclusion 1. Conventional ultrasound can only detect the decrease of global left ventricular systolic function during ischemia. Real-time 3D speckle tracing imaging is of great value in evaluating left ventricular regional myocardial arrest. 2. The global systolic function of left ventricle is delayed after ischemia reperfusion in dogs. There was myocardial depression. 3. The regional systolic function of left ventricle was delayed after ischemia reperfusion in dogs, and compared with the global function. The recovery time of local function is longer. 4. Among the technical indexes of real-time 3D speckle tracing imaging, the area strain index is the most sensitive one, which is expected to be a new index for early diagnosis of angina pectoris of coronary heart disease.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1
【參考文獻】
相關(guān)期刊論文 前10條
1 葉衛(wèi)華;高長青;呂坤;李力兵;閆軍蘭;;人體心臟心室肌纖維三維結(jié)構(gòu)的研究[J];南方醫(yī)科大學(xué)學(xué)報;2010年02期
2 吳宏偉;高健;李韶菁;唐力英;許海玉;唐仕歡;楊洪軍;;基于液相色譜-串聯(lián)質(zhì)譜的氨基酸代謝組學(xué)方法研究黃芪注射液治療腦缺血[J];分析化學(xué);2013年03期
3 付金容;林國生;武智曉;;缺血再灌注心肌中補體C3的表達與補體C1抑制劑的心肌保護作用[J];海南醫(yī)學(xué);2013年01期
4 涂榮會;鐘國強;曾志羽;陳立;何艷;黎慶捷;梁藝夥;;缺氧后處理與氧自由基清除劑預(yù)處理對心肌細胞膜和線粒體Bcl-2和Bax表達的影響[J];中華老年心腦血管病雜志;2012年03期
5 李妮妮;廉哲勛;葛毅萍;王永彬;;缺血后處理和三磷酸腺苷后處理對心肌缺血再灌注損傷的影響[J];中華老年心腦血管病雜志;2010年03期
6 陳旭東;黃國倩;黃克誠;;二維雙平面Simpson法評價高血壓病患者左心房容積及功能[J];中國民族民間醫(yī)藥;2012年24期
7 連醒華;佘亞鵬;趙新民;;二維斑點追蹤成像檢測正常人左心室心肌應(yīng)變[J];生物醫(yī)學(xué)工程與臨床;2011年04期
8 劉文武;馬賓;;線粒體ATP敏感性鉀通道與藥物預(yù)處理心肌保護作用的研究進展[J];實用醫(yī)學(xué)雜志;2010年02期
9 石佳;肖文靜;王古巖;薛慶華;呂紅;何愛霞;袁素;李軍;張U
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