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  本文選題：慢性阻塞性肺疾病 + 右心室功能��； 參考：《泰山醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的 研究慢性阻塞性肺疾�。–OPD）患者右心室局部及整體功能的受損情況，同時探討應(yīng)變率成像和組織速度成像技術(shù)評估COPD患者右心室功能的價值。 方法 入選48例慢性阻塞性肺疾病患者和20例健康對照，采用常規(guī)超聲技術(shù)測量右室前壁舒張末期厚度（RVFT）、右室腔舒張末期前后徑（RVEDd）、主肺動脈內(nèi)徑（MPA）、三尖瓣口反流量及右房大小，依據(jù)三尖瓣口最大反流速度，同時綜合參考三尖瓣口反流量、右房大小來估測肺動脈收縮壓（SPA），根據(jù)SPA大小將COPD患者分成肺動脈高壓組（PAH組）和無肺動脈高壓組（NPAH組）。采用定量組織速度成像技術(shù)測量三尖瓣環(huán)收縮期峰值速度（Vs）、舒張早期峰值速度（Ve）、心房收縮期峰值速度（Va），計算等容收縮期升支斜率IVA、Ve/Va和右室Tei指數(shù)。采用應(yīng)變率成像技術(shù)測量右室游離壁各節(jié)段收縮期峰值應(yīng)變（Ss）、收縮期峰值應(yīng)變率（SRs）、舒張早期峰值應(yīng)變率（SRe）、右房收縮期峰值應(yīng)變率（SRa）。比較各組間上述指標(biāo)的差異，闡明COPD患者右心室局部及整體功能的受損情況及左室射血分?jǐn)?shù)變化情況，并探討應(yīng)變率成像和組織速度成像技術(shù)評估COPD患者右心室功能的價值。 結(jié)果 1. COPD組與健康對照組臨床資料比較 與健康對照組比較，COPD患者心率顯著加快（P＜0.01），吸煙者所占比例明顯增高（P＜0.01）。 2. COPD組與健康對照組常規(guī)超聲測量參數(shù)比較 與健康對照組比較，PAH組RVFT顯著增厚，RVEDd、MPA明顯增大，差異有統(tǒng)計學(xué)意義（P＜0.01）；NPAH組差異無統(tǒng)計學(xué)意義（P＞0.05）。各組間比較，LVEF差異無統(tǒng)計學(xué)意義（P＞0.05）。 3.右室局部收縮、舒張功能參數(shù)比較 與健康對照組比較，NPAH組右室游離壁基底段、中間段的Ss、SRs、SRe、SRa均減低，差異有統(tǒng)計學(xué)意義（P＜0.05）；PAH組右室游離壁基底段、中間段的Ss、SRs、SRe、SRa均明顯減低，差異有統(tǒng)計學(xué)意義（P＜0.01）。與NPAH組比較，PHA組右室游離壁基底段、中間段Ss、SRe明顯減低，差異有統(tǒng)計學(xué)意義（P＜0.01）；SRs、SRa減低，差異有統(tǒng)計學(xué)意義（P＜0.05）。 4.右室整體收縮、舒張功能參數(shù)比較 與健康對照組比較，NPAH組右室游離壁三尖瓣環(huán)處Vs、IVA、Ve、Ve/Va均減低，差異有統(tǒng)計學(xué)意義（P＜0.05）；PAH組右室游離壁三尖瓣環(huán)處Vs、IVA、Ve、Ve/Va均明顯減低，差異有統(tǒng)計學(xué)意義（P＜0.01）。與NPAH組比較，PHA組右室游離壁三尖瓣環(huán)處Vs、Ve減低，差異有統(tǒng)計學(xué)意義（P＜0.05），IVA、Ve/Va減低，差異有統(tǒng)計學(xué)意義（P＜0.01）。 5.右室整體功能參數(shù)比較 與健康對照組比較，NPAH組患者Tei指數(shù)增高，差異有統(tǒng)計學(xué)意義（P＜0.05）；PAH組患者Tei指數(shù)明顯增高，差異有統(tǒng)計學(xué)意義（P＜0.01）。與NPAH組比較，PHA組患者Tei指數(shù)明顯增高，差異有統(tǒng)計學(xué)意義（P＜0.01）。 結(jié)論 1. PAH組患者RVFT增厚，RVEDd、MPA增大，提示右室已發(fā)生重構(gòu)；NPAH組患者右室未發(fā)生代償性重構(gòu)。 2. COPD患者，無論是否伴有肺動脈高壓，右室壁局部收縮和舒張功能均明顯受損；同時，PAH組右室壁局部收縮和舒張功能受損更重。 3. COPD患者，無論是否伴有肺動脈高壓，右室縱向整體收縮、舒張功能明顯受損；同時，PAH組患者右室縱向整體收縮和舒張功能受損更重。本研究還顯示IVA對COPD患者早期收縮功能損害的敏感性較Vs更高，這可能與IVA相對不依賴前、后負(fù)荷，也無心率依賴性有關(guān)。 4. NPAH組患者右室整體功能受損；PAH組患者右室整體功能明顯受損。 5. COPD患者，無論是否伴有肺動脈高壓，心率均增快，而左室射血分?jǐn)?shù)變化不明顯。
[Abstract]:Purpose

To investigate the impairment of right ventricular local and integral function in patients with chronic obstructive pulmonary disease ( COPD ) , and to explore the value of strain rate imaging and tissue velocity imaging in evaluating right ventricular function in patients with COPD .

method

The systolic peak strain ( Ss ) , systolic peak strain rate ( SR ) , early diastolic peak strain rate ( SRe ) and systolic peak strain rate ( SRa ) of tricuspid valve were measured by quantitative tissue velocity imaging technique . The difference of systolic peak strain ( Ss ) , systolic peak strain rate ( SR ) , early diastolic peak strain rate ( SRe ) and right atrium systolic peak strain rate ( SRa ) were measured by quantitative tissue velocity imaging technique .

Results

1 . Comparison of clinical data between COPD group and healthy control group

Compared with the healthy control group , the heart rate of COPD patients was significantly faster ( P < 0.01 ) , and the proportion of smokers increased significantly ( P < 0.01 ) .

2 . Comparison of normal ultrasonic measurement parameters between COPD group and healthy control group

Compared with healthy control group , the RVFT of PAH group was significantly increased , RVEDd and MPA increased significantly ( P < 0.01 ) .
There was no significant difference in LVEF between groups ( P > 0.05 ) .

3 . Comparison of local contraction and diastolic function parameters in right ventricle

Compared with the healthy control group , the Ss , SRs , SRe and SRa in the basal segment and middle segment of the right ventricle in the NPAH group were all decreased , and the difference was statistically significant ( P < 0.05 ) .
Compared with NPAH group , there was significant difference in free wall basal segment , middle segment Ss and SRe of PHA group compared with group NPAH group ( P & lt ; 0.01 ) .
There was significant difference between SRs and SRa ( P < 0.05 ) .

4 . Comparison of left ventricular whole systolic and diastolic function parameters

Compared with the healthy control group , there were significant differences in Vs , iva , Ve , Ve / Va at the free wall tricuspid rings in the right ventricle of the NPAH group ( P < 0.05 ) .
Compared with NPAH group , there was a significant difference in Vs , Ve and Ve / Va in the free wall tricuspid rings ( P < 0 . 05 ) , and the difference was statistically significant ( P < 0 . 01 ) .

5 . Comparison of the overall functional parameters of the right ventricle

Compared with the healthy control group , the Tei index of patients with NPAH increased significantly ( P < 0.05 ) .
Tei index in patients with PAH increased significantly ( P & lt ; 0.01 ) . Compared with group NPAH , Tei index in PHA group was significantly higher than that in group NPAH group ( P & lt ; 0.01 ) .

Conclusion

1 . RVFT thickening , RVEDd , MPA increased in PAH group , suggesting that the right ventricle had been reconstructed ;
No compensatory remodeling occurred in the right ventricle of patients in the NPAH group .

2 . In COPD patients , the local contraction and diastolic function of right ventricular wall were significantly damaged , whether with pulmonary hypertension or pulmonary hypertension .
At the same time , the partial contraction and diastolic function of the right ventricular wall of PAH group were more severe .

3 . Patients with COPD , whether or not accompanied with pulmonary hypertension , left ventricular longitudinal whole systolic and diastolic function were obviously damaged ;
At the same time , the longitudinal overall systolic and diastolic dysfunction in the right ventricle of patients with PAH is more impaired . This study also shows that the sensitivity to early systolic function impairment in patients with COPD is higher than that of Vs , which may be associated with the absence of anterior , posterior , or heart rate dependence in patients with COPD .

4 . The whole function of right ventricle was damaged in NPAH group .
The overall function of the right ventricle in patients with PAH was significantly impaired .

5 . Patients with COPD , regardless of pulmonary hypertension , heart rate increased rapidly , and left ventricular ejection fraction was not obvious .
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.9;R540.45

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本文編號：2029544