發(fā)布時(shí)間：2018-11-13 20:21

【摘要】：目的 1.應(yīng)用血流向量成像技術(shù)（vector flow mapping, VFM）定量評(píng)價(jià)風(fēng)濕性二尖瓣狹窄患者左室渦流，分析瓣膜活動(dòng)對(duì)渦流產(chǎn)生的影響； 2.應(yīng)用斑點(diǎn)追蹤成像技術(shù)（speckle tracking imaging, STI）測(cè)量左室各壁基底段收縮期縱向應(yīng)變及應(yīng)變率，探討二尖瓣狹窄患者左室渦流與局部心肌功能的相關(guān)性。 方法 1.研究對(duì)象：選取對(duì)照組35例健康志愿者，疾病組65例臨床診斷為風(fēng)濕性二尖瓣狹窄患者。 2.儀器：采用ALOKA α10彩色多普勒超聲顯像系統(tǒng)配有DSA-RSl工作站及GE Vivid7彩色多普勒超聲顯像系統(tǒng)配有Echo PAC工作站。 3.方法：經(jīng)常規(guī)超聲心動(dòng)圖檢查后，再分別應(yīng)用血流向量成像技術(shù)與斑點(diǎn)追蹤成像技術(shù)測(cè)量舒張期及等容收縮期左室渦流參數(shù)與左室基底段各壁收縮期縱向應(yīng)變參數(shù)，比較各參數(shù)的組間差異，并將渦流參數(shù)與應(yīng)變參數(shù)進(jìn)行相關(guān)性分析。 結(jié)果 1.舒張期與等容收縮期總渦流強(qiáng)度從對(duì)照組到輕、中度組逐漸增大（P0.05），重度組舒張期總渦流強(qiáng)度與中度組比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05），等容收縮期總渦流強(qiáng)度較中度組減�。≒0.05）。 2.舒張期平均渦流強(qiáng)度從對(duì)照組到輕、中度組逐漸增大，重度組較中度組明顯減�。≒0.05）；等容收縮期平均渦流強(qiáng)度重度組較中度組明顯減�。≒0.05），其余各組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 3.與對(duì)照組比較，，疾病組左室基底段各壁收縮期縱向峰值應(yīng)變及應(yīng)變率降低（P0.05）,而中度組與重度組比較無(wú)顯著性差異（P0.05）。 4.舒張期及等容收縮期總渦流強(qiáng)度與左室基底段收縮期平均峰值應(yīng)變及應(yīng)變率呈負(fù)相關(guān)（r=-0.637~-0.828，P0.001）。 5.二尖瓣開放幅度CE與舒張期平均渦流強(qiáng)度呈負(fù)相關(guān)（r=-0.767，P0.001），其與等容收縮期平均渦流強(qiáng)度無(wú)顯著相關(guān)性（P0.05）。 結(jié)論 1. VFM可用于定量評(píng)估風(fēng)濕性二尖瓣狹窄患者的左室渦流，具有良好的可重復(fù)性，為評(píng)價(jià)異常血流動(dòng)力學(xué)狀態(tài)下的心肌功能提供新的視角。 2. VFM聯(lián)合STI證實(shí)了血流動(dòng)力學(xué)改變與心肌應(yīng)變密切相關(guān)，對(duì)輕中度二尖瓣狹窄患者早期的干預(yù)治療具有重要的臨床意義。
[Abstract]:Objective 1. Flow vector imaging (vector flow mapping, VFM) was used to quantitatively evaluate the left ventricular eddy current in patients with rheumatic mitral stenosis and to analyze the effect of valvular activity on the eddy current. 2. The longitudinal strain and strain rate of basal segment of left ventricle were measured by dot-tracing imaging (speckle tracking imaging, STI) in order to investigate the correlation between left ventricular eddy current and regional myocardial function in patients with mitral stenosis. Method 1. Participants: 35 healthy volunteers and 65 patients with rheumatic mitral stenosis were selected. 2. Instrument: the ALOKA 偽 10 color Doppler ultrasound imaging system is equipped with DSA-RSl workstation and GE Vivid7 color Doppler ultrasound imaging system with Echo PAC workstation. 3. Methods: after routine echocardiography, blood flow vector imaging and dot-tracing imaging were used to measure the parameters of left ventricular eddy current during diastolic and isovolumic systolic periods and the longitudinal strain parameters of left ventricular basal segments. The correlation between eddy current parameters and strain parameters was analyzed. Result 1. The total eddy current intensity in diastolic and isovolumic contraction period increased gradually from control group to mild and moderate group (P0.05), but there was no significant difference between severe group and moderate group (P0.05). The total eddy current intensity in isovolumic contraction period was lower than that in moderate group (P0.05). 2. The mean eddy-current intensity increased gradually from control group to mild group and moderate group, and decreased significantly in severe group compared with moderate group (P0.05). The mean eddy-current intensity in isovolumic contraction period in severe group was significantly lower than that in moderate group (P0.05), but there was no significant difference between other groups (P0.05). 3. Compared with the control group the longitudinal peak strain and strain rate of left ventricular basal segment were decreased in the disease group (P0.05) but there was no significant difference between the moderate group and the severe group (P0.05). 4. The total eddy current intensity in diastolic and isovolumic systolic period was negatively correlated with the mean peak strain and strain rate of left ventricular basal segment (r = 0.637 ~ (-1) -0.828 ~ (-1) P 0.001). 5. The open amplitude of mitral valve (CE) was negatively correlated with the mean eddy-current intensity during diastolic period (r ~ (-0.767) P ~ (0.001), but had no significant correlation with the mean eddy-current intensity during isovolumic contraction (P0.05). Conclusion 1. VFM can be used to quantitatively evaluate left ventricular eddy current in patients with rheumatic mitral stenosis. It has good reproducibility and provides a new perspective for evaluating myocardial function in abnormal hemodynamics. 2. VFM combined with STI confirmed that hemodynamic changes were closely related to myocardial strain and had important clinical significance for early intervention in patients with mild to moderate mitral stenosis.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1

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