【摘要】：目的:1.應(yīng)用超聲斑點(diǎn)追蹤成像(Ultrasound speckle tracking imaging,STI)技術(shù)測量左心室應(yīng)變指標(biāo)研究CABG患者術(shù)前與術(shù)后左心室功能的變化;2.應(yīng)用超聲斑點(diǎn)追蹤成像技術(shù)研究左心房應(yīng)變指標(biāo)與術(shù)后心房顫動(Atrial fibrillation,AF)的相關(guān)性。方法:選取2016年1月1日-2016年10月31日期間河北大學(xué)附屬醫(yī)院心臟外科住院行CABG患者53例,并選擇同期入院檢查的50例正常人做為對照組。1.應(yīng)用常規(guī)經(jīng)胸超聲心動圖分別對正常人及患者在行CABG術(shù)前、術(shù)后4-7d、術(shù)后1個月測量室間隔厚度(IVST)、左心室前后徑、左室射血分?jǐn)?shù)(LVEF);應(yīng)用STI技術(shù)分別對正常人及患者在行CABG術(shù)前、術(shù)后4-7d、術(shù)后1個月進(jìn)行左心室功能指標(biāo)變化的監(jiān)測并進(jìn)行對比分析;2.應(yīng)用常規(guī)經(jīng)胸超聲心動圖分別對正常人及患者在行CABG術(shù)前測定左心房前后徑(LAD)、舒張?jiān)缙诙獍昕绨暄魉俣?E)、舒張晚期二尖瓣跨瓣血流速度(A)、E/A;應(yīng)用STI技術(shù)分別對正常人及患者在行CABG術(shù)前測量左心室收縮期左心房長軸方向整體應(yīng)變(Ss)、左心房收縮期左心房長軸方向整體應(yīng)變(Sa)以及左心房各節(jié)段應(yīng)變率(SRs)。對患者術(shù)后進(jìn)行連續(xù)的心電監(jiān)測,至少72小時。結(jié)果:(1)應(yīng)用STI技術(shù)比較兩組間在二腔心切面、四腔心切面以及三腔心切面整體應(yīng)變值的絕對值,CABG患者左心室的整體應(yīng)變值較對照組減低,術(shù)后組隨橋血管血供時間的延長,各節(jié)段整體應(yīng)變值比術(shù)前組升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)與對照組比較,術(shù)后房顫組所測指標(biāo),E較高,A較低,E/A較高,差異無統(tǒng)計(jì)學(xué)意義(P0.05),LAD較大,Ss、Sa、SRs均較低,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);(3)與對照組比較,術(shù)后非房顫組各項(xiàng)指標(biāo)與其差異無統(tǒng)計(jì)學(xué)意義(P0.05);(4)術(shù)后房顫組與非房顫組比較,Ss、Sa、SRs均較低,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。結(jié)論:(1)STI技術(shù)能無創(chuàng)及定量地評價CABG患者左心室舒縮功能的異常,為CABG術(shù)前、術(shù)后左心室功能的研究評價提供了強(qiáng)有力的新工具;(2)術(shù)前應(yīng)用STI技術(shù)所測得的左心房應(yīng)變值與CABG術(shù)后新發(fā)房顫具有明顯的相關(guān)性,當(dāng)LAD、BMI較高時,Ss、Sa、SRs較低時術(shù)后容易發(fā)生房顫,提示LAD、BMI、Ss、Sa、SRs均為影響CABG術(shù)后是否發(fā)生房顫的危險因素。
[Abstract]:Objective: 1. The changes of left ventricular function in patients with CABG before and after operation were studied by measuring left ventricular strain index by (Ultrasound speckle tracking imaging,STI. 2. The correlation between left atrial strain index and postoperative atrial fibrillation (Atrial fibrillation,AF) was studied by using ultrasonic speckle tracing imaging. Methods: from January 1, 2016 to October 31, 2016, 53 patients with CABG in cardiac surgery department of Hebei University affiliated Hospital were selected, and 50 normal subjects were selected as control group. The left ventricular diameter, left ventricular ejection fraction (LVEF);) and left ventricular septal thickness (IVST),) were measured by conventional transthoracic echocardiography before CABG, 4-7 days after CABG and 1 month after operation. STI technique was used to monitor and compare the changes of left ventricular function indexes in normal subjects and patients before and after CABG for 4-7 days and 1 month postoperatively. 2. Conventional transthoracic echocardiography was used to measure the early mitral flow velocity (A), E / A) before left atrial anterior and posterior diameter (LAD), relaxation in normal subjects and patients before CABG. (E), late diastolic mitral valve velocity (A), E / A); STI technique was used to measure the global strain of left ventricular systolic left atrium long axis direction (Ss), and left atrial long axis strain (Sa) and left atrial strain rate (SRs). Before CABG. Continuous ECG monitoring was performed after operation for at least 72 hours. Results: (1) STI technique was used to compare the absolute values of the global strain between the two groups on the two-chamber, four-chamber and three-chamber central sections. The global strain of the left ventricle in CABG patients was lower than that in the control group. With the prolongation of blood supply time, the global strain value of each segment in the postoperative group was higher than that in the preoperative group, the difference was statistically significant (P0.05). (2) compared with the control group, the indexes of postoperative atrial fibrillation group were higher E, lower A and higher E / A, the difference was not statistically significant (P0.05), LAD was larger, Ss,Sa,SRs was lower, the difference was statistically significant (P0. 05); (3) compared with the control group, there was no significant difference between the indexes of postoperative non-atrial fibrillation group and the control group (P0.05); (4). Compared with the non-atrial fibrillation group, the Ss,Sa,SRs of postoperative AF group was lower, and the difference was statistically significant (P0. 05). Conclusion: (1) STI technique can be used to evaluate the left ventricular systolic and diastolic function of CABG patients in a noninvasive and quantitative manner, which provides a powerful new tool for the study and evaluation of left ventricular function before and after CABG. (2) there was a significant correlation between the left atrial strain measured by STI technique before operation and new atrial fibrillation after CABG. When LAD,BMI was higher, atrial fibrillation was easy to occur when Ss,Sa,SRs was lower, indicating that LAD,BMI,Ss,Sa, was easy to occur after operation. SRs was a risk factor for atrial fibrillation after CABG.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2

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