【摘要】：[目的]通過256層螺旋CT的心功能測定,探討急性主動脈夾層的發(fā)生是否伴有左心室射血分數(shù)的減低。CT、心臟超聲兩種檢查方法在射血分數(shù)測定上進行量化分析,比較兩種方法的相關(guān)性及差異性。初步研究主動脈夾層的Stanford不同分型對左心室射血分數(shù)小于60%者的左心室射血分數(shù)影響的大小。[資料和方法]選擇在我院以急診胸、背或腹部疼痛來院行MSCT全主動脈CTA掃描確診為AD的病人30例,再對這30例患者行回顧性心臟門控掃描,并重建出心臟搏動周期的0%、40%、45%、75%四個時相的圖像,將所有患者四組時相的全部圖像傳入飛利浦EBW (Extended Brilliance Workspace)工作站,用自身攜帶的心功能分析軟件獲取左心室收縮末期(40%)容積、左心室舒張末期(0%)容積,并利用EBW工作站上自帶的心功能后處理軟件Simpson算法計算出所有病人的LVEF值。統(tǒng)計這30例病人CT及心臟超聲分別測定的射血分數(shù)值,利用統(tǒng)計軟件分析這兩組射血分數(shù)值之間的相關(guān)性及差異性。30例病人中心臟后門控掃描LVEF60%者20例,LVEF60%者10例,再根據(jù)主動脈夾層Stanford分型把20例 LVEF60%者分為 Stanford A 型及 Stanford B 型,其中 Stanford A 型 9 例,Stanford B型11例,初步探討這兩種不同分型對所有LVEF60%的患者LVEF值影響的大小。[結(jié)果]30例急性主動脈夾層病人均順利完成心臟后門控掃描及心臟超聲檢查。1.經(jīng)心臟后門控掃描測得LVEF60%者有20例,發(fā)生率67%,平均年齡(57.95±8.61)歲,LVEF60%者有10例,發(fā)生率33%,平均年齡(51.90±8.75)歲。2.CT、心臟超聲兩種方法測得的LVEF值之間經(jīng)pearson's correlation統(tǒng)計具有較高的相關(guān)性 r=0.765, CT: (58.03± 10.84) %,心臟超聲:(60.73 ±5.28) %,經(jīng)配對t檢驗示,兩種方法測得的計量資料之間統(tǒng)計學無差異(P0.05),相對心臟超聲測得的結(jié)果,CT對LVEF值的測定有相對偏低傾向,其偏差約(-2.70±7.60) %。3.經(jīng)心臟后門控掃描并測得LVEF60%患者,其LVEF、年齡符合正態(tài)分布,其中StanfordA型9例,平均LVEF: (53.70±3.96) %,平均年齡:(54.89±9.19)歲,Stanford B 型 11 例,平均 LVEF: (49.05 ±2.39) %,平均年齡:(60.09±5.32)歲,上述兩組LVEF的比較具有統(tǒng)計學差異(P0.05),年齡對比無統(tǒng)計學差異(P0.05)。[結(jié)論](1) MSCT心臟后門控掃描心功能測定能較準確的反映急性AD病人的心功能。(2)急性AD病人的LVEF大多有所減低,MSCTLVEF的測定可作為臨床盡早干預心功能的一項參考指標。(3)不同Stanford分型對LVEF60%的急性AD病人的LVEF影響不同。
[Abstract]:[objective] to investigate whether the occurrence of acute aortic dissection is associated with the decrease of left ventricular ejection fraction (LVEF) by measuring the cardiac function of 256-slice spiral CT. The correlation and difference between the two methods were compared. The effect of Stanford classification on left ventricular ejection fraction (LVEF) in patients with left ventricular ejection fraction (LVEF) less than 60% was studied. [materials and methods] Thirty patients with acute chest, back or abdominal pain diagnosed as AD by MSCT total aortic CTA scan were selected, and 30 patients underwent retrospective cardiac gated scan. At the same time, the images of 75% and 75% of the four phases of the heart beat cycle were reconstructed. All the images of all the four groups of patients were transmitted to Philips EBW (Extended Brilliance Workspace) workstation, and the left ventricular end-systolic volume (40%) was obtained by using the cardiac function analysis software carried by themselves. The left ventricular end-diastolic volume (0%) and the LVEF value of all patients were calculated by the Simpson algorithm of cardiac function postprocessing software on EBW workstation. The ejection fraction was measured by CT and echocardiography in these 30 patients. The correlation and difference between the two groups were analyzed by statistical software. Among the 30 patients, 20 cases (10 / 30) with LVEF60% were examined by backdoor scan, and 10 cases (60%) of LVEF were detected by cardiac backdoor scan. According to the Stanford classification of aortic dissection, 20 patients with LVEF60% were divided into Stanford A and Stanford B, of which 9 were Stanford A and 11 were Stanford B. The effect of these two types on LVEF value of all LVEF60% patients was preliminarily investigated. [results] all the 30 patients with acute aortic dissection completed cardiac backdoor scan and echocardiography. There were 20 cases of LVEF60% detected by cardiac backdoor scan, the incidence rate was 67%, the average age was (57.95 鹵8.61) years old and 10 cases were LVEF 60%. The incidence rate was 330.The average age was (51.90 鹵8.75) years old. 2. The LVEF values measured by two methods of echocardiography had a high correlation with pearson's correlation statistics, r = 0.765, CT: (58.03 鹵10.84), echocardiography: (60.73 鹵5.28) and T test, respectively. There was no statistical difference between the two methods (P0.05). Compared with the results of echocardiography, CT had a tendency to lower the LVEF value, and the deviation was about (-2.70 鹵7.60) .3. The age of LVEF, was normal distribution in 9 cases of StanfordA type, mean LVEF: (53.70 鹵3.96), average age of (54.89 鹵9.19) years, LVEF: (49.05 鹵2.39), mean age of (60.09 鹵5.32) years. The LVEF of the above two groups had statistical difference (P0.05), but the age contrast had no statistical difference (P0.05). [conclusion] (1) the measurement of cardiac function by MSCT backdoor scan can accurately reflect the cardiac function of patients with acute AD. (2) the determination of LVEF in patients with acute AD can be used as a reference index for early intervention of cardiac function in patients with acute AD. (3) the effect of different Stanford classification on LVEF in acute AD patients with LVEF60% was different.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R543.1;R816.2

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