本文選題：子癇前期 + 三維　； 參考：《鄭州大學(xué)》2015年博士論文

【摘要】：研究背景妊娠期,孕婦心臟會(huì)隨心血管負(fù)荷的改變出現(xiàn)適應(yīng)性變化。這些變化對(duì)妊娠的順利進(jìn)展是必需的,但也有可能給孕婦帶來額外的心血管負(fù)擔(dān)。另外,妊娠前原本存在的心臟疾病,如先天性心臟病、風(fēng)濕性心臟病、心肌病、高血壓性心臟病等,由于孕期激素水平變化及心臟負(fù)荷的加重,可能進(jìn)一步發(fā)生惡化。不僅如此,合并心血管并發(fā)癥風(fēng)險(xiǎn)的孕婦數(shù)量也呈現(xiàn)逐年上升的趨勢(shì)。目前,心臟疾病是妊娠期婦女死亡的主要原因,居非產(chǎn)科死亡因素的首位。因此,正確理解和評(píng)價(jià)孕期婦女心血管系統(tǒng)生理性變化對(duì)于全面估測(cè)孕期心血管病風(fēng)險(xiǎn)以及妊娠期婦女的心血管臨床分級(jí)管理是十分重要的。子癇前期(Preeclampsia,PE)是妊娠期特有的疾病,由于血液處于高凝狀態(tài),易發(fā)生心力衰竭以及肝、腎、腦的繼發(fā)性損害,PE是造成孕期及圍生期母體死亡的主要原因。PE可導(dǎo)致心臟冠狀動(dòng)脈水腫痙攣、造成心絞痛、心肌梗死等心血管疾病。尸檢資料表明,PE患者心肌收縮帶壞死的發(fā)生率是妊娠期其他原因死亡者的10倍以上。然而,目前有關(guān)超聲心動(dòng)圖評(píng)價(jià)PE患者心臟損害的報(bào)道并不一致。根據(jù)疾病發(fā)生的時(shí)間,PE分為早發(fā)型和晚發(fā)型。越來越多的證據(jù)表明早發(fā)型和晚發(fā)型PE具有不同的臨床特點(diǎn),應(yīng)作為兩種不同類型的疾病對(duì)待。已經(jīng)有報(bào)道發(fā)現(xiàn)早發(fā)型及晚發(fā)型PE的血流動(dòng)力學(xué)不相同,但對(duì)于心腔形態(tài)及心肌功能是否存在差異未見有詳細(xì)報(bào)道。超聲心動(dòng)圖是目前臨床首選的心臟影像學(xué)檢查手段。傳統(tǒng)超聲心動(dòng)圖檢查具有負(fù)荷依賴性等諸多不足之處,而妊娠期婦女恰恰正處于心血管負(fù)荷急劇變化的時(shí)期,因此,傳統(tǒng)超聲心動(dòng)圖技術(shù)對(duì)于孕期婦女心臟形態(tài)及功能的評(píng)價(jià)更有局限性。由于使用不同的技術(shù)方法、觀測(cè)指標(biāo)以及研究對(duì)象的不同等原因,目前有關(guān)正常妊娠及PE婦女心臟形態(tài)及功能的研究結(jié)果并不一致。新近的實(shí)時(shí)三維超聲斑點(diǎn)追蹤成像技術(shù)(three-dimensional speckle-tracking echocardiography,3D STE)是基于超聲斑點(diǎn)追蹤成像的實(shí)時(shí)三維超聲心動(dòng)圖技術(shù)(real time three-dimensional echocardiograph,RT-3DE),該技術(shù)通過在三維立體空間內(nèi)追蹤小于入射超聲波長(zhǎng)的細(xì)小結(jié)構(gòu)所產(chǎn)生的聲學(xué)散射斑點(diǎn)信息,不僅可以顯示心臟的三維立體空間,而且可以區(qū)分心肌在長(zhǎng)軸、軸向、圓周等各方向的主動(dòng)變形能力及被動(dòng)運(yùn)動(dòng),在敏感、準(zhǔn)確地評(píng)價(jià)心肌運(yùn)動(dòng)以及收縮、舒張功能方面顯示出獨(dú)特的優(yōu)勢(shì)。有研究證明,除了測(cè)量三個(gè)方向上的心肌應(yīng)變,3D STE還可以通過獨(dú)特的面積應(yīng)變指標(biāo)對(duì)左心室整體和局部的功能做出全面的評(píng)估,可以克服傳統(tǒng)二維超聲等技術(shù)的缺點(diǎn),從而更為準(zhǔn)確、可靠地評(píng)價(jià)心臟形態(tài)及功能。本課題利用3D STE技術(shù)研究PE婦女左心房室重構(gòu)、心功能及心肌變形能力,對(duì)比分析早發(fā)型和晚發(fā)型PE患者的左心腔形態(tài)及心功能差異;評(píng)價(jià)正常妊娠婦女左心室及左心房的形態(tài)、功能特點(diǎn),建立妊娠婦女在不同孕周心臟結(jié)構(gòu)及功能指標(biāo)的三維超聲心動(dòng)圖正常值范圍。這項(xiàng)研究豐富了PE及正常妊娠婦女的心血管相關(guān)信息,為該類患者的臨床心血管分級(jí)管理提供了可靠的參考依據(jù)。第一部分3D STE技術(shù)評(píng)價(jià)正常妊娠婦女左心結(jié)構(gòu)及功能的研究1研究目的利用3D STE評(píng)估正常妊娠婦女左心室形態(tài)、功能以及左心房的容積、功能隨著孕周的變化,建立妊娠婦女在不同孕周心臟結(jié)構(gòu)及功能指標(biāo)的三維超聲心動(dòng)圖正常值范圍,初步探討正常妊娠期左心重構(gòu)的機(jī)制,為臨床正確評(píng)價(jià)妊娠婦女左心功能提供影像學(xué)依據(jù)。2研究方法 2.1研究對(duì)象所有研究對(duì)象均來源于2012年1月~2013年2月在鄭州大學(xué)第三附屬醫(yī)院門診就診及住院的女性。其中,Na組:健康妊娠婦女68人,分別在妊娠第12~14周、24~27周、36~39周以及分娩后6~9周利用二維超聲及3D STE進(jìn)行左心室形態(tài)及功能的研究。Nb組:43例正常Nb組妊娠的孕婦分別在孕11~14周,24~32周和35~39周利用RT-3DE進(jìn)行左心房容積、功能的研究。Ca組與Cb組分別為30例年齡匹配的健康非孕育齡女性。2.2儀器及圖像采集受試者左側(cè)臥位,應(yīng)用GE vivid E9超聲診斷儀,M5S探頭行常規(guī)二維超聲心動(dòng)圖檢查,包括胸骨旁及心尖觀的脈沖多普勒檢查。V4探頭進(jìn)行三維全容積掃查。全部影像數(shù)據(jù)利用Echo PAC GE Healthcare軟件包進(jìn)行分析。2.3記錄指標(biāo)分別測(cè)量二維室間隔厚度、左室后壁厚度、左室壁相對(duì)厚度、左室舒張末期內(nèi)徑及收縮末期內(nèi)徑;三維左室舒張末期容積、收縮末期容積、每搏輸出量、心輸出量、射血分?jǐn)?shù)以及左心室球形指數(shù)。Nb組M型超聲測(cè)量左心房的前后徑,進(jìn)行左心房形態(tài)三維重建,獲取左心房的最大容積,收縮前容積和最小容積,計(jì)算左心房總排空分?jǐn)?shù)、主動(dòng)及被動(dòng)排空分?jǐn)?shù)。2.4統(tǒng)計(jì)分析描述性數(shù)據(jù)由均數(shù)±標(biāo)準(zhǔn)差(x±s)表現(xiàn)。隊(duì)列研究采用單因素方差分析結(jié)合Bonferroni校正的方法,數(shù)值比較采用獨(dú)立樣本t檢驗(yàn)。實(shí)時(shí)三維應(yīng)變率與二維應(yīng)變率比較采用配對(duì)t檢驗(yàn)。3結(jié)果1.隨著妊娠的延續(xù),Na組心臟指數(shù)逐漸升高,左心室發(fā)生離心性重構(gòu);晚孕期,左室整體心肌縱向應(yīng)變、圓周應(yīng)變、面積應(yīng)變及徑向應(yīng)變輕微下降,伴隨左心室射血分?jǐn)?shù)輕微降低(P0.05),但是這些變化在產(chǎn)后均恢復(fù)至產(chǎn)前水平。2.Nb組E/e逐漸升高,左心房容量逐漸增大,左心房總排空分?jǐn)?shù)、被動(dòng)及主動(dòng)排空分?jǐn)?shù)均逐漸增高;到孕晚期,左心房最大容積及排空分?jǐn)?shù)達(dá)到最高值,最小容積達(dá)到最低值。4結(jié)論隨著妊娠進(jìn)展,正常妊娠婦女心臟生理性肥大,心肌應(yīng)變輕微下降,左心房容積增大、房泵功能逐漸加強(qiáng)。本部分研究利用3D STE提供了正常妊娠婦女在早、中、晚孕期左心房室形態(tài)及功能生理變化的三維超聲影像數(shù)據(jù)以及三維心肌應(yīng)變的數(shù)據(jù)。第二部分3D STE技術(shù)評(píng)價(jià)子癇前期患者左心室結(jié)構(gòu)及收縮功能的研究1研究目的旨在利用3D STE研究PE患者左心室形態(tài)及功能變化情況,與正常妊娠婦女進(jìn)行對(duì)比分析;并進(jìn)一步評(píng)價(jià)早發(fā)型和晚發(fā)型PE患者是否存在心腔形態(tài)及心肌功能差異,為產(chǎn)科臨床心血管疾病的分級(jí)管理提供參考信息。2研究方法 2.1研究對(duì)象所有研究對(duì)象均來源于2012年1月~2013年2月在鄭州大學(xué)第三附屬醫(yī)院門診就診及住院的女性。其中,PEa組:84例PE患者,其中,43例早發(fā)型PEa(孕周34周)為PEa1組,41例晚發(fā)型PEa(發(fā)病孕周≥34周)為PEa2組;PE入選標(biāo)準(zhǔn)按照國(guó)際妊娠期高血壓研究協(xié)會(huì)的規(guī)定執(zhí)行。從Na組挑選與PEa組年齡、孕周匹配的健康妊娠婦女,分別稱為Na1及Na2組。Ca組:30例年齡匹配的健康非孕育齡婦女作為空白對(duì)照組。2.2儀器及圖像采集受試者左側(cè)臥位,應(yīng)用GE vivid E9超聲診斷儀,M5S探頭行常規(guī)二維超聲心動(dòng)圖檢查,包括胸骨旁及心尖觀的脈沖多普勒檢查。V4探頭進(jìn)行三維全容積掃查。全部影像數(shù)據(jù)利用Echo PAC GE Healthcare軟件包進(jìn)行分析。2.3記錄指標(biāo)分別測(cè)量二維室間隔、左室后壁及左室壁相對(duì)厚度,左室舒張末期內(nèi)徑及收縮末期內(nèi)徑;三維左室舒張末期容積、收縮末期容積、每搏輸出量、心輸出量、射血分?jǐn)?shù)以及左心室球形指數(shù);三維左室整體心肌縱向、圓周、面積及徑向應(yīng)變等指標(biāo)。2.4統(tǒng)計(jì)分析應(yīng)用SPSS 17.0軟件,所有計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示。PEa組、Na組與Ca組數(shù)值比較采用獨(dú)立樣本t檢驗(yàn),PEa1與PEa2患者資料的比較采用了協(xié)方差分析。數(shù)值相關(guān)性采用Pearson相關(guān)分析。以α=0.05為檢驗(yàn)水準(zhǔn)。3結(jié)果1.PEa組與Na組相比,其左心室的內(nèi)徑及容積增大,左室壁增厚以及室壁相對(duì)厚度增加,同時(shí),PE患者的左心室質(zhì)量指數(shù)及球形指數(shù)升高;PEa組比Na組左心室射血分?jǐn)?shù)、縮短分?jǐn)?shù)及組織多普勒心肌收縮期運(yùn)動(dòng)s峰顯著下降,同時(shí)三維心肌應(yīng)變指標(biāo)出現(xiàn)下降。2.與PEa2組相比,PEa1組患者的左室容積及左心室質(zhì)量指數(shù)增加更明顯,三維心肌圓周、面積及徑向應(yīng)變明顯降低,而且,發(fā)生局部應(yīng)變減低的心肌節(jié)段數(shù)目較晚發(fā)型多。3.所有的實(shí)時(shí)三維應(yīng)變指標(biāo)與孕周呈相關(guān)關(guān)系(P0.01);和其他指標(biāo)相比,GAS與射血分?jǐn)?shù)、球形指數(shù)呈較好的相關(guān)性(r分別為0.549、0.328),是唯一與左室質(zhì)量指數(shù)相關(guān)的指標(biāo)(r=0.22)。4結(jié)論1.PE患者比正常妊娠婦女的心臟后負(fù)荷增加,左心室呈離心性肥大;心臟泵功能降低,三維心肌應(yīng)變減低。2.與晚發(fā)型PE相比,早發(fā)型PE發(fā)生了更嚴(yán)重的左心室重構(gòu)及心肌損害。第三部分RT-3DE技術(shù)定量分析子癇前期患者左心房容積和功能的研究1研究目的本研究使用RT-3DE技術(shù)研究PE患者左心房的容積及功能特點(diǎn);對(duì)比分析早發(fā)型和晚發(fā)型PE的左心房形態(tài)和功能差異,并結(jié)合左心室舒張功能特點(diǎn)初步探討PE時(shí)左心房重構(gòu)的機(jī)制。2研究方法 2.1研究對(duì)象所有研究對(duì)象均來源于2012年1月~2013年2月在鄭州大學(xué)第三附屬醫(yī)院門診就診及住院的女性。其中,PEb組:本研究共納入70例PE患者,其中,36例早發(fā)型(PEb1組)和34例晚發(fā)型PE(PEb2組)。從Nb組挑選與PEb組年齡、孕周匹配的健康妊娠婦女,分為Nb1組和Nb2組,進(jìn)行超聲心動(dòng)圖和血流動(dòng)力學(xué)檢查。30例年齡匹配的健康非孕育齡女性作為空白對(duì)照組(Cb組)。2.2儀器及圖像采集受試者左側(cè)臥位,應(yīng)用GE vivid E9超聲診斷儀,M5S探頭行常規(guī)二維超聲心動(dòng)圖檢查,包括胸骨旁及心尖觀的脈沖多普勒檢查。V4探頭進(jìn)行三維全容積掃查。全部影像數(shù)據(jù)利用Echo PAC GE Healthcare軟件包進(jìn)行分析。2.3記錄指標(biāo)分別測(cè)量二維室間隔厚度、左室后壁厚度、左室壁相對(duì)厚度、左室舒張末期內(nèi)徑及收縮末期內(nèi)徑;三維左室舒張末期容積、收縮末期容積、每搏輸出量、心輸出量、射血分?jǐn)?shù)以及左心室球形指數(shù)。M型超聲測(cè)量左心房的前后徑,進(jìn)行左心房形態(tài)三維重建,獲取左心房的最大容積,收縮前容積和最小容積,計(jì)算左心房總排空分?jǐn)?shù)、主動(dòng)及被動(dòng)排空分?jǐn)?shù)。2.4統(tǒng)計(jì)分析描述性數(shù)據(jù)由均數(shù)±標(biāo)準(zhǔn)差(x±s)表現(xiàn)。PEb、Nb與Cb組間數(shù)值比較采用獨(dú)立樣本t檢驗(yàn)。PEb1與PEb2組資料的比較采用了協(xié)方差分析的方法。各參數(shù)之間的關(guān)系采用Pearson相關(guān)系數(shù)分析。以α=0.05為檢驗(yàn)水準(zhǔn)。3結(jié)果1.PEb組與Nb組相比,其舒張?jiān)缙诙獍暄鱁峰流速與組織多普勒二尖瓣環(huán)運(yùn)動(dòng)速度e的比值,即E/e比值,明顯升高;同時(shí),所有左心房容積指數(shù)明顯增高,排空分?jǐn)?shù)顯著降低。2.PEb1與PEb2組相比,其舒張晚期血流速度A波及E/e升高,左心房收縮前容積減小、主動(dòng)排空分?jǐn)?shù)降低。3.左心房的最大容積和所有排空分?jǐn)?shù)與孕周呈正相關(guān)。左心房容積指標(biāo)與心率、心輸出量及二尖瓣環(huán)舒張?jiān)缙谶\(yùn)動(dòng)速度呈負(fù)相關(guān);與左心室質(zhì)量、左心室充盈壓呈正相關(guān)。然而,左心房排空分?jǐn)?shù)和以上指標(biāo)的關(guān)系恰恰相反。4結(jié)論1.PE患者較正常妊娠婦女心室充盈壓明顯升高、心肌舒張功能障礙,導(dǎo)致左心房的明顯擴(kuò)張和房泵功能降低。2.與晚發(fā)型相比,早發(fā)型PE患者左心房的容積較小、主動(dòng)排空的能力明顯降低。
[Abstract]:In the study of pregnancy, the heart of the pregnant woman will be adaptable to changes in the cardiovascular load. These changes are necessary for the smooth progress of pregnancy, but it may also bring an extra cardiovascular burden to pregnant women. In addition, the original heart disease, such as congenital heart disease, rheumatic heart disease, cardiomyopathy, and hypertension, is the same. Heart disease, due to changes in hormone levels in pregnancy and aggravation of heart load, may further deteriorate. Not only that, the number of pregnant women with cardiovascular complications is also increasing year by year. At present, heart disease is the main cause of the death of women in pregnancy and is the first factor in non obstetric death. Therefore, it is correctly understood. The physiological changes of cardiovascular system in pregnant women are important for the overall assessment of the risk of cardiovascular disease during pregnancy and the management of cardiovascular clinical grades in pregnant women. Preeclampsia (Preeclampsia, PE) is a special disease of pregnancy. Due to the high coagulation state of blood, it is easy to have heart failure and secondary liver, kidney, and brain. PE is the main cause of maternal death during pregnancy and perinatal period.PE can cause coronary artery edema spasm, angina pectoris, myocardial infarction and other cardiovascular diseases. Autopsy data show that the incidence of myocardial contractile necrosis in PE patients is more than 10 times more than those of other causes of pregnancy. However, current echocardiography is related to echocardiography The assessment of heart damage in PE patients is not consistent. According to the time of the disease, PE is divided into early onset and late onset. More and more evidence suggests that early onset and late onset PE have different clinical characteristics and should be treated as two different types of disease. There have been reports that the hemodynamics of early and late onset PE are different, However, there is no detailed report on the difference of heart cavity shape and cardiac function. Echocardiography is the first choice for clinical examination of cardiac imaging. Acoustic cardiogram is more limited in the evaluation of cardiac shape and function in pregnant women. Due to the use of different technical methods, observation indexes and different research objects, the results of the study on normal pregnancy and PE women's heart form and function are not consistent. Recent real-time three-dimensional ultrasound speckle tracking imaging techniques The technique (three-dimensional speckle-tracking echocardiography, 3D STE) is a real-time three-dimensional echocardiography (real time three-dimensional echocardiograph, RT-3DE) based on ultrasonic speckle tracking imaging (real time three-dimensional echocardiograph, RT-3DE). This technique is used to track the acoustic scattering spots produced by a small structure less than the ultrasonic wavelength in three-dimensional space. Information can not only display the three-dimensional space of the heart, but also distinguish the active deformability and passive motion of the myocardium in all directions, such as the long axis, the axis, the circumference, and so on. It shows unique advantages in sensitive and accurate evaluation of cardiac muscle movement and systolic and diastolic function. 3D STE can also make a comprehensive assessment of the overall and local function of the left ventricle through a unique area strain index, and can overcome the shortcomings of the traditional two-dimensional ultrasound technology, so as to evaluate the heart shape and function more accurately and reliably. This subject uses 3D STE to study the left ventricular remodeling, cardiac function and myocardial deformation of the PE women. Ability to compare the left ventricular shape and cardiac function difference between early and late onset PE patients; to evaluate the morphological and functional characteristics of left and left atrium in normal pregnant women and to establish the normal range of three-dimensional echocardiography of pregnant women in different gestational weeks. This study enriches PE and normal pregnant women. Cardiovascular related information to provide a reliable reference for the clinical cardiovascular management of this type of patients. Part 1 3D STE technique to evaluate the left heart structure and function of normal pregnant women. 1 the purpose of the study was to evaluate the left ventricular shape, function, and the volume of left atrium in normal pregnant women with 3D STE. To establish the normal range of three-dimensional echocardiography of pregnant women in different gestational weeks, to explore the mechanism of left heart remodeling in normal pregnancy, and to provide a correct evaluation of the left heart function of pregnant women in order to provide the correct evaluation of the left heart function of pregnant women. All the subjects of the research object of.2 study 2.1 were all from 2 January 2012. 2 Women in the Third Affiliated Hospital of Zhengzhou University were hospitalized and hospitalized in the Third Affiliated Hospital of Zhengzhou University. Among them, 68 healthy pregnant women were studied at week 12~14, 24~27 weeks, 36~39 weeks and 6~9 weeks after delivery, respectively, using two-dimensional ultrasound and 3D STE to study the left ventricular form and function in group.Nb: 43 cases of normal Nb group pregnant women were at pregnant 11~14, 24~32, respectively. The volume and function of left atrium using RT-3DE at week and 35~39 weeks was studied in group.Ca and group Cb for 30 age matched healthy non pregnant women of childbearing age.2.2 instrument and image acquisition subjects left lateral position, GE vivid E9 ultrasonic diagnostic instrument, and M5S probe routine two-dimensional echocardiography, including sternum and apical pulse Doppler. The.V4 probe was examined for three-dimensional full volume scan. All image data were analyzed by Echo PAC GE Healthcare software package. The thickness of two-dimensional ventricular septum, left ventricular posterior wall thickness, left ventricular wall thickness, left ventricular end diastolic diameter and end systolic diameter, three-dimensional left ventricular end diastolic volume, end systolic volume, were measured respectively. A three-dimensional reconstruction of left atrium was performed for the left atrium, the maximum volume of left atrium, the volume of the left atrium and the minimum volume, the total left atrial emptying score, and the statistical analysis of the active and passive emptying fraction.2.4 for the statistical analysis of the descriptive data of the left atrium, the left atrium was reconstructed in the left atrium by M type ultrasound of the cardiac output, cardiac output, ejection fraction and.Nb group of the left ventricle index group. In the cohort study, the single factor variance analysis combined with Bonferroni correction was used in the cohort study. The independent sample t test was used for numerical comparison. The real-time three-dimensional strain rate and the two-dimensional strain rate were compared with the paired t test.3 results 1. with the continuation of pregnancy, the cardiac index of the Na group increased gradually and the left ventricular remodeling was centrifuged. 1. In the late pregnancy, the longitudinal strain of the left ventricular myocardium, the circumference strain, the area strain and the radial strain were slightly decreased, with the left ventricular ejection fraction slightly decreased (P0.05), but these changes were all restored to the pre natal level of the.2.Nb group, the E/e increased gradually, the left atrium volume increased gradually, the left atrium total emptying fraction, passive and active emptying score were all In the late pregnancy, the maximum volume and emptying score of the left atrium reached the highest value, and the minimum volume reached the lowest value.4. With the progress of pregnancy, the normal pregnancy women had a physiological hypertrophy, a slight decrease in the myocardial strain, the increase of the left atrium volume and the function of the room pump. This part of the study used the 3D STE to provide the normal pregnant women. Three-dimensional echocardiographic data and data of three-dimensional myocardial strain during the early, middle and late pregnancy left atrial ventricular morphology and function. Second 3D STE technique was used to evaluate the left ventricular structure and systolic function of preeclampsia. 1 the purpose of the study was to study the changes of left ventricular form and function in PE patients with 3D STE, and the purpose of the study. Comparative analysis of pregnant women, and further evaluation of the existence of heart cavity morphology and myocardial function differences between early and late onset PE patients, providing reference information.2 research methods for the classification management of clinical cardiovascular disease 2.1 all of the subjects were derived from the Third Affiliated to Zhengzhou University in February January 2012. The PEa group: 84 cases of PE patients, among them, 43 cases of early onset PEa (34 weeks of pregnancy) were group PEa1, 41 cases of late onset PEa (or more than 34 weeks of pregnancy) were group PEa2; PE admission standard was performed according to the international pregnancy hypertension research association. Group Na1 and group Na2, group.Ca, respectively: 30 age matched non pregnant women of childbearing age as the blank control group.2.2 instrument and the left lateral decubitus of the image acquisition subjects, the GE vivid E9 ultrasonic diagnostic instrument, the M5S probe routine two-dimensional echocardiography, including the sternal and apical pulse Doppler examination.V4 probe. All image data were analyzed by Echo PAC GE Healthcare software package. The.2.3 recording index was used to measure the two-dimensional ventricular septum, left ventricular posterior wall and left ventricular wall relative thickness, left ventricular end diastolic diameter and end systolic diameter, three-dimensional left ventricular end diastolic volume, end systolic volume, stroke volume, cardiac output and ejection fraction. As well as the left ventricular globular index, the.2.4 statistical analysis of the longitudinal, circumference, area and radial strain of the whole left ventricular myocardium was applied to the SPSS 17 software. All the data were expressed in.PEa group with mean mean + standard deviation (x + s). The values of Na and Ca were compared by independent sample t, and the covariance analysis was used in the comparison of the data between PEa1 and PEa2 patients. Pearson correlation analysis was used in numerical correlation. With alpha =0.05 as the test level.3 results, the left ventricular diameter and volume of the 1.PEa group increased, the left ventricular wall thickening and the relative thickness of the ventricular wall increased, while the left ventricular mass index and the spherical index of the PE patients increased, and the PEa group shortened the score and tissue of the left ventricular ejection fraction in the group Na. The s peak of myocardial systolic movement of Doppler decreased significantly, and the three dimensional myocardial strain index decreased with.2.. Compared with the PEa2 group, the left ventricular volume and the left ventricular mass index in the PEa1 group were more obvious, the three dimensional myocardial circumference, the area and the radial strain decreased obviously, and the number of myocardial segments with local strain reduction was more.3 in the late period. All real time three-dimensional strain indicators were associated with pregnancy (P0.01). Compared with other indicators, GAS had a better correlation with the ejection fraction and the spherical index (R 0.549,0.328, respectively), and was the only index associated with the left ventricular mass index (r=0.22).4 conclusion that the cardiac afterload of 1.PE patients was higher than that of normal pregnant women, and the left ventricle was centrifuged. Sexual hypertrophy; decreased cardiac pump function and reduced.2. in three-dimensional myocardial strain compared with late onset PE; early onset PE had more serious left ventricular remodeling and myocardial damage. Part third RT-3DE quantitative analysis of left atrial volume and function in preeclampsia patients. 1 research objective to study the volume of left atrium in PE patients using RT-3DE technique The morphological and functional differences of left atrium in early and late onset PE were compared and analyzed, and the mechanism of left atrium remodeling in PE was preliminarily discussed in combination with the characteristics of left ventricular diastolic function. 2.1 the subjects of the study 2.1 subjects were all from the Third Affiliated Hospital of Zhengzhou University in February January 2012. A total of 70 patients with PE were included in this study, including 36 patients with early onset (group PEb1) and 34 late type PE (group PEb2). From group Nb, the age of PEb group and pregnancy matched healthy pregnant women were divided into Nb1 group and Nb2 group. Echocardiography and blood flow mechanics were used to examine.30 age matched non pregnant women of childbearing age. In the blank control group (group Cb), the left lateral position of the.2.2 instrument and the image acquisition subjects was used, the GE vivid E9 ultrasonic diagnostic instrument was used, the M5S probe was examined by the conventional two-dimensional echocardiography, including the sternal and apical pulse Doppler examination.V4 probe for three-dimensional full volume scan. All the image data were carried out by Echo PAC GE Healthcare software package. The thickness of two-dimensional ventricular septum, posterior wall thickness of left ventricle, relative thickness of left ventricular wall, left ventricular end diastolic diameter and end systolic diameter, three-dimensional left ventricular end diastolic volume, end systolic volume, cardiac output, cardiac output, ejection fraction, and left ventricle index.M ultrasound were measured before and after.2.3 recording. Three dimensional reconstruction of left atrial morphology was performed to obtain the maximum volume of the left atrium, the volume and volume of the left anterior chamber.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R714.244;R540.45

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