【摘要】：目的： 利用斑點(diǎn)追蹤顯像技術(shù)初步評(píng)價(jià)二尖瓣機(jī)械瓣置換術(shù)后患者左室心肌內(nèi)、外膜的扭轉(zhuǎn)和旋轉(zhuǎn)運(yùn)動(dòng)。 方法： 選擇二尖瓣機(jī)械瓣置換術(shù)后(包含雙瓣置換術(shù)后)患者21例和正常對(duì)照組25例。應(yīng)用斑點(diǎn)追蹤顯像技術(shù)測(cè)定左室短軸切面基底段和心尖段心肌內(nèi)、外膜及整體的收縮期最大旋轉(zhuǎn)角度,同時(shí)計(jì)算整個(gè)左室內(nèi)、外膜及整體的最大扭轉(zhuǎn)角度,并在兩組之間進(jìn)行對(duì)比。將瓣膜置換組左室心肌內(nèi)、外膜及整體的旋轉(zhuǎn)和扭轉(zhuǎn)角度與左室射血分?jǐn)?shù)、舒張末期左室內(nèi)徑及左房?jī)?nèi)徑的進(jìn)行相關(guān)性分析,并將瓣膜置換組按手術(shù)術(shù)式、術(shù)后時(shí)間和左室射血分?jǐn)?shù)水平進(jìn)行分組分析。 結(jié)果： 1.對(duì)比對(duì)照組,瓣膜置換術(shù)組左心射血分?jǐn)?shù)明顯降低(P=0.002)；收縮期心尖水平內(nèi)膜(P=0.010)旋轉(zhuǎn)角度減少,外膜(P=0.003)及整體(P=0.004)旋轉(zhuǎn)角度明顯減少,收縮期左室內(nèi)膜(P=0.006)、外膜(P=0.002)及整體(P=0.002)扭轉(zhuǎn)角度明顯減少,而基底水平旋轉(zhuǎn)角度無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 2.瓣膜置換組收縮期基底水平和心尖水平的心肌外膜及整體旋轉(zhuǎn)角度與LVEF呈中度相關(guān),左室扭轉(zhuǎn)角度與LVEF呈中度相關(guān)；收縮期心尖段旋轉(zhuǎn)角度及左室扭轉(zhuǎn)角度與LVDd呈中度相關(guān)。 3.瓣膜置換組內(nèi)比較：LVEF60%組較LVEF≥60%組其收縮期心肌內(nèi)、外膜及整體扭轉(zhuǎn)角均明顯減低(P0.01)。 結(jié)論： 二尖瓣機(jī)械瓣置換術(shù)后患者較正常人左室射血分?jǐn)?shù)減低,并存在左室旋轉(zhuǎn)及扭轉(zhuǎn)運(yùn)動(dòng)損害,心尖段旋轉(zhuǎn)運(yùn)動(dòng)及左心扭轉(zhuǎn)運(yùn)動(dòng)受損明顯,其中外膜旋轉(zhuǎn)和扭轉(zhuǎn)運(yùn)動(dòng)受損程度較明顯,基底段旋轉(zhuǎn)運(yùn)動(dòng)受損不明顯。左室旋轉(zhuǎn)和扭轉(zhuǎn)運(yùn)動(dòng)影響LVEF水平,其中外膜的旋轉(zhuǎn)和扭轉(zhuǎn)運(yùn)動(dòng)與LVEF相關(guān)性最好。心功能損害其心內(nèi)、外膜和整體扭轉(zhuǎn)運(yùn)動(dòng)均受損。
[Abstract]:Objective: to evaluate the torsion and rotation of left ventricular adventitia after mitral valve replacement by speckle tracing imaging. Methods: 21 patients after mitral mechanical valve replacement (including double valve replacement) and 25 normal control group were selected. The maximal systolic rotation angles of the basal and apical segments of the left ventricular short axis were measured by speckle tracing imaging, and the maximal torsion angles of the whole left ventricle, the epineurium and the whole heart were calculated. A comparison was made between the two groups. The relationship between left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEH) and left atrial diameter (LVAD) in the valve replacement group was analyzed by the rotation and torsion angles of the left ventricular myocardium, adventitia and the whole body, and the valve replacement group was operated on. Time after operation and left ventricular ejection fraction (LVEF) were analyzed in groups. Results: 1. Compared with the control group, the left ventricular ejection fraction (LVEF) in the valvular replacement group was significantly decreased (P0. 002). The rotation angle of the lateral intima (P0. 010) was decreased, the rotation angle of the adventitia (P0. 003) and the whole (P0. 004) was decreased, and the left ventricular intima (P0. 006) in the systolic phase. The torsion angle of the outer membrane (P0. 002) and the whole (P0. 002) decreased significantly, but the horizontal rotation angle of the substrate was not statistically significant (P0.05). 2. In valvular replacement group, the myocardial epicardial and global rotation angle of systolic basal level and apical level were moderately correlated with LVEF, and the angle of left ventricular torsion was moderately correlated with LVEF, and the rotation angle of systolic apical segment and left ventricular torsion angle were moderately correlated with LVDd. 3. Compared with LVEF 鈮，

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