【摘要】：目的：探討實時三維超聲心動圖（RT-3DE）技術評價房間隔缺損（ASD）患者手術前后右房功能的臨床價值。 方法：對54例房間隔缺損患者采用RT-3DE監(jiān)測術前、術后2~3天、1個月、3個月時右心房最大容積（RAVmax）、右心房最小容積（RAVmin）及右心房收縮前容積（RAVpre），右房總射血容量（TASV）、右房被動射血容量（PASV）、右房主動射血容量（AASV）、右房整體射血分數(shù)（RAEF）、右房被動射血分數(shù)（RAEFpassive）、右房主動射血分數(shù)（RAEFactive）。常規(guī)超聲心動圖監(jiān)測右房橫徑（RA）、右室內徑（RV）、主肺動脈內徑（MPA）、肺動脈收縮壓、左室舒張末期內徑（LVd）、左室收縮末期內徑（LVs）、左室每搏輸出量（LVSV）、左室射血分數(shù)（LVEF）以及30例正常組的上述血流動力學指標。分別比較正常組、ASD術前組與ASD術后各組間的結果。 結果：ASD患者RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV及MPA均高于正常組，RAEF和RAEFpassive指標均低于正常組,差異有統(tǒng)計學意義（P0.05），提示ASD患者術前右房存儲功能、泵功能增強，管道功能減低，右房橫徑、右室內徑及主肺動脈內徑增寬。ASD患者術后2～3天RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV及MPA均低于術前組，RAEFpassive指標高于術前組，差異有統(tǒng)計學意義（P0.05）；ASD患者術后3個月RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV、MPA、RAEF和RAEFpassive指標與正常組相比較，差異無統(tǒng)計學意義（P0.05）。ASD術后，右房存儲功能、泵功能、管道功能逐漸恢復正常，右房橫徑、右室及主肺動脈內徑縮小，，肺動脈收縮壓明顯下降，左室內徑增大，左室每搏量、左室射血分數(shù)增高，心臟重構在隨訪中持續(xù)逆轉，其血流動力學明顯改善，大多數(shù)ASD患者術后三個月右房大小及心室功能基本恢復到正常水平。 結論：ASD手術糾正了心臟解剖畸形和血流動力學異常; RT-3DE能夠方便檢測ASD手術前后右心血流動力學改變，反映右心功能改變，為臨床評價其病變的嚴重程度、判斷預后及掌握ASD術后的恢復情況提供可靠的參考依據(jù)。
[Abstract]:Objective: to evaluate the clinical value of real-time three-dimensional echocardiography (RT-3DE) in the evaluation of right atrial function in patients with atrial septal defect (ASD) before and after operation. Methods: 54 patients with atrial septal defect were monitored by RT-3DE before, 2 days, 1 month and 3 months after operation. The maximal right atrium volume (RAVmax), the minimum right atrial volume (RAVmin) and the right atrial presystolic volume (RAVpre),) were used. Right atrial total ejection volume (TASV), right atrial passive ejection volume (PASV), right atrial active ejection volume (AASV), right atrium global ejection fraction (RAEF), right atrial passive ejection fraction (RAEFpassive), right atrial active ejection fraction (RAEFactive). Routine echocardiography monitoring right atrial diameter (RA), right ventricular diameter (RV), pulmonary artery diameter (MPA), pulmonary artery systolic pressure left ventricular end diastolic diameter (LVd), left ventricular end systolic diameter (LVs), left ventricular stroke volume (LVSV), Left ventricular ejection fraction (LVEF) and hemodynamic parameters were measured in 30 normal subjects. The results of normal group, pre-ASD group and post-ASD group were compared. Results: the levels of RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA in patients with ASD were higher than those in normal group, while the indexes of RAEF and RAEFpassive in patients with ASD were lower than those in normal group (P0.05), suggesting that the function of right atrium storage and pump in patients with ASD were enhanced before operation. The diameter of right atrium, right ventricle and main pulmonary artery were widened in patients with ASD. RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA were lower than those in preoperative group at 2 days and 3 days after operation, and RAEFpassive indexes were higher than those in preoperative group. The difference was statistically significant (P0.05); There was no significant difference in RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV,MPA,RAEF and RAEFpassive between ASD patients and normal group 3 months after operation (P0.05). Right atrial storage function, pump function and pipeline function gradually returned to normal after operation. The diameter of right atrium, the diameter of right ventricle and main pulmonary artery decreased, the systolic pressure of pulmonary artery decreased significantly, the inner diameter of left ventricle increased, left ventricular stroke volume and left ventricular ejection fraction increased, cardiac remodeling continued to reverse during follow-up, and its hemodynamics was improved obviously. The size of right atrium and ventricular function returned to normal level in most patients with ASD three months after operation. Conclusion: ASD operation can correct cardiac anatomical malformation and hemodynamic abnormality. RT-3DE can conveniently detect the hemodynamic changes of the right heart before and after ASD operation, reflect the changes of the right heart function, and provide reliable reference for evaluating the severity of the lesion, judging the prognosis and mastering the recovery of the patients after ASD.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R654.2;R540.45

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