本文選題：實(shí)時(shí)三維超聲心動(dòng)圖 + 三維斑點(diǎn)追蹤技術(shù)��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1、探討實(shí)時(shí)三維超聲心動(dòng)圖(RT-3DE)及三維斑點(diǎn)追蹤技術(shù)(3D-STI)評(píng)價(jià)老年心房顫動(dòng)患者左心室容積及泵血功能的價(jià)值。2、應(yīng)用實(shí)時(shí)三維超聲新技術(shù)聯(lián)合三尖瓣環(huán)收縮期位移(TAPSE)及下腔靜脈塌陷率(△IVC)評(píng)估老年房顫患者右室結(jié)構(gòu)與收縮功能變化。方法:選取80例持續(xù)性孤立性房顫病史大于20年的老年患者為病例組(B組),平均年齡約81.2歲;同期80例健康體檢老年人為對(duì)照組(A組),平均年齡約79.9歲。1、測(cè)量A、B兩組常規(guī)超聲參數(shù):左房舒張末期最大面積(LAA)、左心室舒張末期最大內(nèi)徑(LVDd)、Simpson法左心室射血分?jǐn)?shù)(LVEF)、二尖瓣反流面積(MRA),并計(jì)算MRA/LAA面積百分比、室間隔厚度(IVSTd)、左心室收縮末期最小內(nèi)徑(LVDs)、左心室舒張功能指標(biāo)E/E,、右房舒張末期最大面積(RAA);右心室舒張末期基底部橫徑(Basal RVd)、三尖瓣反流面積(TRA),并計(jì)算TRA/RAA面積百分比、肺動(dòng)脈收縮壓(PASP)、右室面積變化分?jǐn)?shù)(RVFAC)、右心室舒張功能指標(biāo)e/e,、三尖瓣環(huán)收縮期位移(TAPSE)及下腔靜脈塌陷率(△IVC)。2、測(cè)量A、B兩組實(shí)時(shí)三維超聲參數(shù):左心室收縮末期最小容積(LVESV)、左心室射血分?jǐn)?shù)(RT-LVEF)、左心室舒張末期最大容積(LVEDV);右室收縮末期最小容積(RVESV)、右室射血分?jǐn)?shù)(RVEF)、右室舒張末期最大容積(RVEDV)。3、測(cè)量A、B兩組三維斑點(diǎn)追蹤成像參數(shù):左心室整體面積收縮期峰值應(yīng)變(LVGAS)、左心室整體縱向收縮期峰值應(yīng)變(LVGLS)、左心室整體圓周收縮期峰值應(yīng)變(LVGCS)、左心室整體徑向收縮期峰值應(yīng)變(LVGRS)。結(jié)果:1、常規(guī)二維超聲測(cè)量結(jié)果:病例組B組與參照組A組相比,LVDs、IVSTd、PWd無明顯變化(P均0.05);LVDd、LAA、MRA、E/E’、BasalRVd、TRA、RAA、PASP、e/e’、MRA/LAA、TRA/RAA呈升高趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05或0.01);RVFAC、TAPSE、△IVC、LVEF有減低趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、三維實(shí)時(shí)超聲技術(shù)測(cè)量結(jié)果:病例組B組與參照組A組相比,LVEDV、LVESV、RVEDV、RVESV呈增大趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05或0.01);RT-LVEF、RVEF有減低趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05或0.01)。3、三維超聲斑點(diǎn)追蹤技術(shù)測(cè)值結(jié)果:LVGLS、LVGCS、LVGRS、LVGAS絕對(duì)值有減低趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05或0.01)。結(jié)論:1.長(zhǎng)期心律控制不佳的老年房顫患者心臟結(jié)構(gòu)及功能發(fā)生變化,表現(xiàn)為雙房明顯增大,左右心室容積增加,心臟收縮及舒張功能均降低,左心室各方向應(yīng)變值均減低;三尖瓣反流較二尖瓣反流明顯,肺動(dòng)脈壓力增高。2.實(shí)時(shí)三維超聲心動(dòng)圖及三維斑點(diǎn)追蹤成像技術(shù)能夠?qū)夏晷姆款潉?dòng)患者左右心室容積及泵血功能進(jìn)行評(píng)估。在臨床診斷、治療、判斷病情進(jìn)展及預(yù)后中有一定參考價(jià)值。
[Abstract]:Objective to evaluate the value of real-time three-dimensional echocardiography RT-3DEand 3D speckle tracing technique in evaluating left ventricular volume and blood pump function in elderly patients with atrial fibrillation. Methods A new real-time three-dimensional echocardiography combined with systolic position of tricuspid annulus was used to evaluate the left ventricular volume and blood pump function in elderly patients with atrial fibrillation. The changes of right ventricular structure and systolic function in elderly patients with atrial fibrillation were evaluated by TAPSE and IVC. Methods: 80 elderly patients with persistent solitary atrial fibrillation for more than 20 years were selected as group B with an average age of 81.2 years. During the same period, 80 healthy elderly persons were treated as control group A, with an average age of 79.9 years. The parameters of conventional echocardiography in two groups were measured: left atrial end diastolic maximum area (LAA), left ventricular end-diastolic maximum diameter (LVDdU) and left ventricular ejection fraction (LVEFV). Mitral regurgitation area (MRAA) and MRA/LAA area percentage were calculated. The left ventricular septal thickness, left ventricular end systolic minimum diameter, left ventricular diastolic function index E / E, right atrial end diastolic maximum area, right ventricular end diastolic base transverse diameter and tricuspid regurgitation area were calculated, and the percentage of TRA/RAA area was calculated. Pulmonary artery systolic pressure (PAP), right ventricular area change fraction (RVFAC), right ventricular diastolic function index (E / E), tricuspid annular systolic displacement (TAPSE) and inferior vena cava collapse rate (IVCV) were measured in two groups: left ventricular end-systolic minimum. Left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDVV), right ventricular end-systolic minimum volume (RVESVV), right ventricular ejection fraction (RVEFV), right ventricular end-diastolic maximum volume (RVEDVV), right ventricular end-diastolic volume (RVEDVV). The peak systolic strain of whole ventricular area is LVGASA, the peak strain of left ventricular whole longitudinal systolic period is LVGLSN, the peak strain of left ventricular whole peripheral systolic period is LVGCSC, and the peak strain of left ventricular whole radial systolic period is LVGRSs. Results: compared with control group A, there was no significant change in LVDsSV IVSTdT PWD in case group B and control group A (P < 0.05). There was a trend of decrease in IVC LVEF, and there was a trend of decrease in IVC LVEF, and there was a trend of increase in RVFACTAPSE.IVCLVEF was decreased in group B (P 0.05, P 0.05 or P < 0.05), but there was a trend of decrease in LVEF in IVC LVEF, and there was no significant difference between group B and group A (P > 0.05) in the results of routine two-dimensional ultrasound measurements of two dimensional ultrasound. The results showed that there was a tendency to increase in group B, and there was a significant difference between group B and group A (P 0.05 or P 0.05). There was a significant difference in RVESV between group B and group A, and the RVESV of RVEVV in group B was significantly higher than that in group A, and the difference was significant (P0.05) or 0.01% (RT-LVEFV / RVEF), and the RVESV of RVEVEF in group B was significantly lower than that in group A (P < 0.05), and there was a decrease in RVESV between group B and group A (P < 0.05). The results showed that the absolute value of LVGRSs in LVGCSN / LVGCSN / LVGRSs / LVGAS decreased significantly, and the difference was statistically significant (P0.05) or 0.01g / L (P < 0.05). The results showed that the absolute value of LVGRSs in LVGRSs was significantly lower than that in the control group (P < 0.05). Conclusion 1. The changes of cardiac structure and function in elderly patients with chronic atrial fibrillation were as follows: the volume of left and right ventricle increased, the volume of left and right ventricle increased, the systolic and diastolic function of the left ventricle decreased, and the strain values of left ventricle decreased in all directions. Tricuspid regurgitation was more obvious than mitral regurgitation, and pulmonary artery pressure was higher than that of mitral regurgitation. Real-time three-dimensional echocardiography and three-dimensional speckle tracing imaging can be used to evaluate left and right ventricular volume and blood pump function in elderly patients with atrial fibrillation. It has certain reference value in clinical diagnosis, treatment, judgement of disease progress and prognosis.
【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)】：R541.75;R540.45

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