三維超聲心動(dòng)圖評(píng)價(jià)老年房間隔缺損封堵術(shù)前后左右心室收縮功能
發(fā)布時(shí)間：2019-05-24 23:55
【摘要】：背景：早先房間隔缺損（ASD）后確診采取開胸修補(bǔ)手術(shù)治療創(chuàng)傷大并存在一定危險(xiǎn)性，成人特別是老年ASD患者多不愿接受；近年封堵術(shù)介入治療ASD創(chuàng)傷小危險(xiǎn)性低，逐漸被許多成人甚至是老年患者接受。以往有學(xué)者應(yīng)用M型和二維超聲心動(dòng)圖（2DE）測(cè)定ASD手術(shù)前后心室功能，目前尚無應(yīng)用三維超聲心動(dòng)圖（3DE）評(píng)價(jià)老年ASD封堵術(shù)前后左右心室收縮功能的報(bào)道，本研究即是采用3DE技術(shù)對(duì)老年ASD封堵術(shù)介入治療前后心室收縮功能進(jìn)行評(píng)價(jià)。 目的：應(yīng)用3DE評(píng)價(jià)老年ASD封堵術(shù)前后左右心室收縮功能變化。 材料和方法：本研究從2010年3月至2014年3月，在沈陽軍區(qū)總醫(yī)院住院的35例老年孤立性ASD患者，其中男性7例，女性28例，年齡60至75歲（平均64.2歲）。ASD直徑最小8mm，最大28mm，平均18.2mm，ASD六個(gè)緣（上下緣、前后緣和上下腔靜脈緣）長度均≥7mm，其中伴有輕-中度肺動(dòng)脈高壓12例，肺動(dòng)脈收縮壓力均在60mmHg以內(nèi)，心房水平均為左向右分流，伴有輕度二尖瓣關(guān)閉不全11例，伴有輕-中度二尖瓣關(guān)閉不全5例，伴有輕度三尖瓣關(guān)閉不全12例，伴有輕度-中度三尖瓣關(guān)閉不全6例。使用PhilipsiE33型彩色多普勒超聲心動(dòng)圖（CDE）診斷儀，具有M型超聲心動(dòng)圖、2DE、脈沖多普勒（PW）、連續(xù)多普勒（CW）和彩色多普勒血流顯像（CDFI）五種常用功能，探頭頻率1～5MHz，另配1個(gè)X3-1探頭。分別在封堵術(shù)前1天、封堵術(shù)后1天、1周、1個(gè)月、3個(gè)月和6個(gè)月進(jìn)行2DE及3DE檢查。先應(yīng)用M型超聲心動(dòng)圖和2DE進(jìn)行常規(guī)檢查，測(cè)量各參數(shù)；應(yīng)用2DE測(cè)量ASD直徑，CDFI顯示過房間隔彩色分流束，判斷ASD大小；應(yīng)用CDFI觀察過心臟瓣膜反流情況，判斷關(guān)閉不全的程度；再應(yīng)用CW測(cè)定三尖瓣反流頻譜，獲取速度峰值，根據(jù)簡(jiǎn)化的伯努利方程（ΔP=4V2）估測(cè)肺動(dòng)脈壓力值。最后更換X3-1探頭行3DE檢查，分別對(duì)左右心室進(jìn)行取樣獲取三維數(shù)據(jù)庫，隨后脫機(jī)使用Qlab軟件進(jìn)行處理分析，依次采集手術(shù)前和手術(shù)后左室舒張末期容積、左室收縮末期容積、左室每搏輸出量以及左室射血分?jǐn)?shù)（即LVEDV、LVESV、LVSV以及LVEF）；右室舒張末期容積、右室收縮末期容積、右室每搏輸出量以及右室射血分?jǐn)?shù)（即RVEDV、RVESV、RVSV以及RVEF）。將封堵術(shù)前后檢測(cè)上述數(shù)值進(jìn)行統(tǒng)計(jì)學(xué)成對(duì)t檢驗(yàn)，比較兩組間差異，P㩳0.05差異性顯著。 結(jié)果：35例老年ASD在CDE實(shí)時(shí)監(jiān)視下均成功實(shí)施封堵術(shù)介入治療，術(shù)后CDE復(fù)查無并發(fā)癥，所有患者封堵器位置及形態(tài)均正常，無殘余分流。3DE測(cè)定LVEDV、LVESV以及LVSV從封堵術(shù)后1天開始逐漸增大；封堵術(shù)介入治療后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月、術(shù)后6個(gè)月與封堵術(shù)前相比較上述測(cè)值均明顯增大（P㩳0.01）；術(shù)后1個(gè)月與術(shù)后1天相比較，差異性顯著（P㩳0.01）；封堵術(shù)介入治療后6個(gè)月與封堵術(shù)介入治療后術(shù)后1個(gè)月相比較，差異性不顯著（P㧐0.05）。RVEDV、RVESV以及RVSV從介入封堵術(shù)后1天開始逐漸縮��；封堵術(shù)介入治療后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月、術(shù)后6個(gè)月與封堵術(shù)介入治療前相比較上述測(cè)值均明顯縮小，術(shù)后1個(gè)月與術(shù)后1天相比較，，差異性顯著（P㩳0.01）；術(shù)后6個(gè)月與術(shù)后1個(gè)月相比較，差異性不顯著（P㧐0.05）；LVEF、RVEF封堵術(shù)介入治療術(shù)前與術(shù)后相比較，差異性不顯著（P㧐0.05）。 結(jié)論：老年ASD封堵術(shù)介入治療后由于阻斷心房水平異常分流，從術(shù)后1天左右心室的容積即發(fā)生改變，且1天至1個(gè)月內(nèi)改變明顯，從1個(gè)月以后開始趨于穩(wěn)定，LVEF和RVEF封堵術(shù)后改變不明顯。3DE技術(shù)評(píng)價(jià)心功能具有簡(jiǎn)便、快速、更準(zhǔn)確等優(yōu)點(diǎn)，應(yīng)用3DE測(cè)定老年ASD封堵術(shù)前后心功能可取代有創(chuàng)的心血管造影檢查。
[Abstract]:BACKGROUND: The diagnosis of atrial septal defect (ASD) after atrial septal defect (ASD) has a high degree of trauma and a certain risk, especially in elderly patients with ASD. In recent years, the small risk of ASD is low and is gradually accepted by many adults and even older patients. In the past, the ventricular function before and after ASD was measured by using M-type and two-dimensional echocardiography (2DE), and no three-dimensional echocardiography (3DE) was used to evaluate the left and right ventricular systolic function of the elderly ASD. This study is to evaluate the ventricular systolic function before and after the interventional treatment of the elderly ASD with the 3DE technique. Objective: To evaluate the effect of 3DE in the treatment of left and right ventricular contraction in elderly patients with ASD. Materials and Methods: From March 2010 to March 2014,35 elderly patients with isolated ASD were hospitalized in the General Hospital of Shenyang Military Region, including 7 males and 28 females, aged 60 to 75 years (average 64). The diameter of ASD was 8 mm, the maximum 28 mm, the average of 18.2 mm, the length of the six edges of the ASD (upper and lower, anterior and inferior vena cava) was 7 mm, with 12 cases of light-to-moderate pulmonary hypertension, and the systolic pressure of the pulmonary artery was within 60 mmHg, and the atrial level was left to the left. Right shunt with mild mitral insufficiency in 11 cases with mild-to-moderate mitral insufficiency in 5 cases with mild tricuspid insufficiency in 12 cases with mild-to-moderate tricuspid valve closure A total of 6 cases were used. There are five common functions of M-type echocardiography, 2DE, pulse Doppler (PW), continuous Doppler (CW) and color Doppler flow imaging (CDFI). The frequency of the probe is 1-5 MHz and the other is X3- 1 probe.2 DE and 3 D for 1 day,1 week,1 month,3 months and 6 months after the occlusion, respectively,1 day before closure. E. First, use M-type echocardiography and 2DE for routine examination to measure the parameters; apply 2DE to measure ASD diameter, CDFI to display the transseptal color shunt, and judge the size of ASD; and observe the heart valve regurgitation by using CDFI and judge the insufficiency. To the extent that the frequency spectrum of the tricuspid regurgitation was measured by CW, the peak value was obtained, and the pulmonary artery was estimated according to the simplified Bernoulli equation (Supp = 4V2). The pressure value was measured. Finally, the three-dimensional database was sampled for the left and right ventricles, and then the left ventricular end-diastolic volume and the left ventricular end-systolic volume were collected before and after the operation. Phase volume, left ventricular stroke volume, and left ventricular ejection fraction (i.e., LVEDV, LVESV, LVSV, and LVEF); right ventricular end-diastolic volume, right ventricular end-systolic volume, right ventricular stroke volume, and right ventricular ejection fraction (i.e., RVEDV, RVESV, RVSV, and RV EF). The above-mentioned values were tested for statistical paired t-test before and after the plugging operation, and the difference between the two groups was compared, and the difference between the two groups was P-0.05. Results:35 elderly patients with ASD were successful in the interventional treatment under the real-time monitoring of CDE. The postoperative CDE reexamination had no complications, and the position and morphology of all the patients were normal and there was no residual shunt. The results showed that the LVEDV, LVESV and LVSV were open after the occlusion. The results were gradually increased,1 month after operation,1 month after operation,3 months after operation,6 months after operation, and 3 months after operation, the above measured values were significantly increased in 6 months after operation (P <0.01), and the difference was significant after 1 month after operation and 1 day after operation (P? 0.01). The difference was not significant (P? 0.05) after 6 months after the interventional treatment and 1 month after the operation. The RVEDV, the RVESV and the RVSV were gradually reduced from one day after the intervention. The occlusion was 1 week after the interventional treatment and one month after the operation. Compared with the one-day post-operation, the difference was not significant (P? 0.05). LVEF and RVEF were compared with operation before and after operation, and the difference was not significant (P? Conclusion: After the interventional treatment of the elderly ASD, the volume of the left ventricle is changed from 1 day to 1 month due to the abnormal shunt of the blocking of the atrial level, and the change is obvious from 1 day to 1 month, from 1 month to 1 month. The results showed that the changes of cardiac function were simple, rapid, and more accurate in the treatment of the cardiac function with 3DE, and the cardiac function before and after the closure of the ASD was replaced by the 3DE technique.
【學(xué)位授予單位】：大連醫(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)】：R540.45;R654.2
[Abstract]:BACKGROUND: The diagnosis of atrial septal defect (ASD) after atrial septal defect (ASD) has a high degree of trauma and a certain risk, especially in elderly patients with ASD. In recent years, the small risk of ASD is low and is gradually accepted by many adults and even older patients. In the past, the ventricular function before and after ASD was measured by using M-type and two-dimensional echocardiography (2DE), and no three-dimensional echocardiography (3DE) was used to evaluate the left and right ventricular systolic function of the elderly ASD. This study is to evaluate the ventricular systolic function before and after the interventional treatment of the elderly ASD with the 3DE technique. Objective: To evaluate the effect of 3DE in the treatment of left and right ventricular contraction in elderly patients with ASD. Materials and Methods: From March 2010 to March 2014,35 elderly patients with isolated ASD were hospitalized in the General Hospital of Shenyang Military Region, including 7 males and 28 females, aged 60 to 75 years (average 64). The diameter of ASD was 8 mm, the maximum 28 mm, the average of 18.2 mm, the length of the six edges of the ASD (upper and lower, anterior and inferior vena cava) was 7 mm, with 12 cases of light-to-moderate pulmonary hypertension, and the systolic pressure of the pulmonary artery was within 60 mmHg, and the atrial level was left to the left. Right shunt with mild mitral insufficiency in 11 cases with mild-to-moderate mitral insufficiency in 5 cases with mild tricuspid insufficiency in 12 cases with mild-to-moderate tricuspid valve closure A total of 6 cases were used. There are five common functions of M-type echocardiography, 2DE, pulse Doppler (PW), continuous Doppler (CW) and color Doppler flow imaging (CDFI). The frequency of the probe is 1-5 MHz and the other is X3- 1 probe.2 DE and 3 D for 1 day,1 week,1 month,3 months and 6 months after the occlusion, respectively,1 day before closure. E. First, use M-type echocardiography and 2DE for routine examination to measure the parameters; apply 2DE to measure ASD diameter, CDFI to display the transseptal color shunt, and judge the size of ASD; and observe the heart valve regurgitation by using CDFI and judge the insufficiency. To the extent that the frequency spectrum of the tricuspid regurgitation was measured by CW, the peak value was obtained, and the pulmonary artery was estimated according to the simplified Bernoulli equation (Supp = 4V2). The pressure value was measured. Finally, the three-dimensional database was sampled for the left and right ventricles, and then the left ventricular end-diastolic volume and the left ventricular end-systolic volume were collected before and after the operation. Phase volume, left ventricular stroke volume, and left ventricular ejection fraction (i.e., LVEDV, LVESV, LVSV, and LVEF); right ventricular end-diastolic volume, right ventricular end-systolic volume, right ventricular stroke volume, and right ventricular ejection fraction (i.e., RVEDV, RVESV, RVSV, and RV EF). The above-mentioned values were tested for statistical paired t-test before and after the plugging operation, and the difference between the two groups was compared, and the difference between the two groups was P-0.05. Results:35 elderly patients with ASD were successful in the interventional treatment under the real-time monitoring of CDE. The postoperative CDE reexamination had no complications, and the position and morphology of all the patients were normal and there was no residual shunt. The results showed that the LVEDV, LVESV and LVSV were open after the occlusion. The results were gradually increased,1 month after operation,1 month after operation,3 months after operation,6 months after operation, and 3 months after operation, the above measured values were significantly increased in 6 months after operation (P <0.01), and the difference was significant after 1 month after operation and 1 day after operation (P? 0.01). The difference was not significant (P? 0.05) after 6 months after the interventional treatment and 1 month after the operation. The RVEDV, the RVESV and the RVSV were gradually reduced from one day after the intervention. The occlusion was 1 week after the interventional treatment and one month after the operation. Compared with the one-day post-operation, the difference was not significant (P? 0.05). LVEF and RVEF were compared with operation before and after operation, and the difference was not significant (P? Conclusion: After the interventional treatment of the elderly ASD, the volume of the left ventricle is changed from 1 day to 1 month due to the abnormal shunt of the blocking of the atrial level, and the change is obvious from 1 day to 1 month, from 1 month to 1 month. The results showed that the changes of cardiac function were simple, rapid, and more accurate in the treatment of the cardiac function with 3DE, and the cardiac function before and after the closure of the ASD was replaced by the 3DE technique.
【學(xué)位授予單位】：大連醫(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)】：R540.45;R654.2
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