發(fā)布時(shí)間：2018-02-08 09:58

  本文關(guān)鍵詞： 左心房功能 實(shí)時(shí)三維超聲心動(dòng)圖 缺鐵性貧血　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用實(shí)時(shí)三維超聲心動(dòng)圖(RT-3DE)評(píng)價(jià)缺鐵性貧血患者左心房功能。方法:選取2014年11月至2016年4月來自我院血液科、婦產(chǎn)科、消化科住院患者65例,貧血時(shí)間均6個(gè)月以上,將65名患者的血紅蛋白濃度(Hb)分為B、C兩組,B組:血紅蛋白(Hb)90 g/L(年齡25~65歲,平均年齡48.8±14.1歲,病程7個(gè)月~15年);C組:血紅蛋白(Hb)60~90 g/L(年齡22~62歲,平均年齡47.6±16.6歲;病程8個(gè)月~14年)。其中由婦科疾病如子宮肌瘤、腺肌癥、月經(jīng)量增多導(dǎo)致的貧血的患者38例,由消化系統(tǒng)疾病如胃大部分切除術(shù)導(dǎo)致的貧血的患者18例,由其他原因?qū)е碌腎DA原因待查的患者9例。B、C兩組貧血患者均為臨床確診為缺鐵性貧血患者,排除先天性因素、糖尿病、冠心病、甲亢、高血壓等導(dǎo)致的心臟病,排除胃腸道惡性腫瘤術(shù)后接受化療、放療的患者,也排除有家族病史及其他慢性病史。另外選取30名在我院體檢的正常健康人(年齡23~64歲,平均年齡47.0±14.5歲)作為對(duì)照組(A組),正常健康人組無家族病史及其他病史,且體格檢查、心電圖、胸片、超聲心動(dòng)圖及血液實(shí)驗(yàn)室化驗(yàn)指標(biāo)均正常。應(yīng)用美國GE公司出產(chǎn)的Vivid E9彩色多普勒超聲診斷設(shè)備,配備了M5S-D探頭(頻率1.5~4.5 MHz)及4V-D探頭(頻率1.7~3.3 MHz),并且配備了相關(guān)分析軟件。常規(guī)二維超聲以及RT-3DE所測(cè)量數(shù)據(jù)參數(shù)如下。1.常規(guī)記錄被檢查者性別、年齡、心率、血壓。囑被檢查者均取左側(cè)臥位,平靜呼吸,首先對(duì)各組被檢查者進(jìn)行常規(guī)經(jīng)胸超聲心動(dòng)圖檢查,完成二維圖像采集及所需參數(shù)測(cè)量,主要包括左心房收縮末期前后徑(LADs)、左室舒張末期內(nèi)徑(LVDd)、舒張末期室間隔厚度(IVSTd)、舒張末期左室下側(cè)壁厚度(PWTd)。頻譜多普勒測(cè)量參數(shù)主要包括二尖瓣瓣口E峰、A峰血流速度及E/A比值。2.對(duì)各組被檢查者應(yīng)用RT-3DE對(duì)左心房相關(guān)參數(shù)進(jìn)行測(cè)定。三維測(cè)定參數(shù)主要包括左心房最大容積(LAVmax)、左心房最小容積(LAVmin)、左心房主動(dòng)收縮前容積(LAVp),用體表面積(BSA)將以上數(shù)據(jù)進(jìn)行校正,得出左心房容積指數(shù)LAVImax、LAVImin、LAVIp,計(jì)算左心房射血分?jǐn)?shù)(LAEF)、左心房被動(dòng)射血分?jǐn)?shù)(LAPEF)、左心房主動(dòng)射血分?jǐn)?shù)(LAAEF)。結(jié)果:1.常規(guī)超聲測(cè)量結(jié)果顯示:B組所有數(shù)據(jù)與A組所有數(shù)據(jù)對(duì)比無統(tǒng)計(jì)學(xué)意義(均P0.05)。C組LADs、A峰與A組、B組比較均增大(均P0.05),E峰、E/A減小(均P0.05)。2.RT-3DE測(cè)量結(jié)果顯示:B組所有數(shù)據(jù)與A組所有數(shù)據(jù)對(duì)比無統(tǒng)計(jì)學(xué)意義(均P0.05)。C組LAAEF、LAVIp、LAVImax、LAVImin與A、B組比較明顯增大(均P0.05),LAPEF、LAEF顯著減低(均P0.05)。結(jié)論:RT-3DE可以有效地評(píng)估缺鐵性貧血患者的左心房功能。
[Abstract]:Objective: to evaluate the left atrial function in patients with iron deficiency anemia by real-time three-dimensional echocardiography (RT-3DE). Methods: from November 2014 to April 2016, 65 inpatients from hematology department, obstetrics and gynecology department and digestive department in our hospital were selected, and the anemia time was more than 6 months. The hemoglobin concentration of 65 patients was divided into two groups: group B: hemoglobin B group: hemoglobin Hb1 90g / L (mean age: 48.8 鹵14.1 years old, 25 ~ 65 years old). The course of disease ranged from 7 months to 15 years in group C: hemoglobin HbBX 60g / L (22 ~ 62 years old, mean age 47.6 鹵16.6 years); The course of disease ranged from 8 months to 14 years. Among them, 38 cases were anaemia caused by gynecological diseases such as hysteromyoma, adenomyosis and increased menstrual volume, and 18 cases were anemia caused by digestive system diseases such as gastrectomy. Nine patients with IDA caused by other causes, all of whom were clinically diagnosed with iron deficiency anemia, were excluded from congenital factors, diabetes, coronary heart disease, hyperthyroidism, hypertension, etc. Patients who received chemotherapy and radiotherapy after operation for gastrointestinal malignancies were also excluded from family history and other chronic diseases. Another 30 healthy persons (aged 23 to 64 years) who were examined in our hospital were selected. The average age was 47.0 鹵14.5 years old) as control group A group, normal control group had no family history and other medical history, and physical examination, electrocardiogram, chest radiography, Echocardiography and blood laboratory tests were normal. Vivid E9 color Doppler ultrasound diagnostic equipment produced by GE Company was used. The M5S-D probe (frequency 1.5mm 4.5 MHz) and the 4V-D probe (frequency 1.73.3 MHz) were equipped with correlation analysis software. The parameters measured by conventional two-dimensional ultrasound and RT-3DE were as follows: 1. Routine recording of sex, age, heart rate, Blood pressure. The subjects were told to take the left supine position and breathe calmly. First of all, routine transthoracic echocardiography was performed to collect the two-dimensional images and measure the required parameters. The main parameters include left atrial anterior and posterior diameter LADsN, left ventricular end diastolic diameter (LVDdN), end diastolic septal thickness (IVSTD) and left ventricular inferior wall thickness (PWTdN). Spectral Doppler parameters mainly include mitral valve orifice E peak A blood flow. Velocity and E / A ratio .2.The parameters related to left atrium were measured by RT-3DE in each group. The three dimensional parameters mainly include left atrium maximal volume, left atrial minimum volume, left atrial active presystolic volume, left atrial active presystolic volume and body surface. Area BSA) to correct the above data, The left atrial volume index (LAVImax1 / LAVImin1 / LAVIp) was obtained, the left atrial ejection fraction (Laff), the left atrial passive ejection fraction (LAPEFG) and the left atrial active ejection fraction (LAAEFN) were calculated. Results: 1. Routine ultrasound measurements showed that all data in Group B were not consistent with those in Group A. Statistical significance (all P0.05 + .C group compared with group A and A group) increased (P 0.05) E peak E / A decreased (P0.05 + 2.RT-3DE results showed that there was no statistical significance between all data of group B and group A (all P0.05.C group LAAEFLAVIpImaxLAVImin and Aneb group). The results showed that there was no significant difference between group A and group A (all P0.05.C group). The results showed that there was no statistical significance between group A and group A (all P0.05.C group). The results showed that there was no statistical difference between group A and group A (all P0.05.C group). Large (P0.05) LAPEFLAEF was significantly decreased (P 0.05). Conclusions: RT-3DE can effectively evaluate the left atrial function in patients with iron deficiency anemia.
【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】：2017
【分類號(hào)】：R556.3;R540.45

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