实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值

发布时间：2018-01-15 05:11

  本文关键词：实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 实时三维超声心动图 常规超声心动图 肺动脉高压 右心室功能

【摘要】：目的应用实时三维超声心动图(real time three-dimensional echocardiography,RT-3DE)技术定量测量中、重度肺动脉高压(pulmonary hypertension,PAH)患者的右室容积和射血分数,并将其与常规超声心动图参数进行对比研究,旨在探讨RT-3DE技术评估中、重度PAH患者右室收缩功能的临床价值,并寻找常规超声心动图参数中可敏感评估不同程度PAH患者右室收缩功能的可靠指标。方法30例健康志愿者作为对照组(Ⅰ组),确诊的中、重度PAH患者各25例,将其分为中度组(Ⅱ组50mmHgPASP≤70mmHg)、重度组(Ⅲ组PASP70mmHg)。一般情况:测量并记录每位受检者的年龄、身高、体重、心率等一般情况。常规超声心动图参数:使用M5S探头,分别测量并记录右心房的左右径(right atrial left and right diameter,RA-D1)、右心房的上下径(right atrial upper and lower diameter,RA-D2)、右心室基底部的左右径(right ventricular basal diameter,RV-D)、右室游离壁厚度(right ventricular free wall thickness,RV-FW),三尖瓣最大反流速度(the maximum regurgitant velocity,V)、估测肺动脉收缩压(pulmonary artery systolic pressure,PASP),右室面积变化分数(right ventricular fractional area change,RVFAC)、三尖瓣环收缩期峰值速度(tricuspid annular systolic peak velocity,S’)、右室心肌做工指数(right ventricular myocardial performance index,RIMP)、三尖瓣环收缩期位移(tricuspid annular systolic displacement,TAPSE)。实时三维超声心动图参数:应用4V探头,连续采集3个心动周期的右室动态三维形态模型并储存,进入Echo PAC工作站,启用4D Auto RVQ程序,终可得出右室舒张末容积(right ventricular end diastolic volume,RVEDV)、右室收缩期容积(right ventricular systolic volume,RVESV)、右室每博输出量(right ventricular stroke volume,RVSV)及右室射血分数(right ventricular ejection fraction,RVEF)。探讨应用RT-3DE技术评估右室收缩功能的重复性,并对3组中以上各参数进行对比分析,探讨各参数随PASP增高的变化趋势,并分析各参数与PASP之间,三维参数RVEF与S’、RIMP、TAPSE、RVFAC间的相关性。结果1.一般情况:各组间参与者的年龄、心率、体重、身高的差异均无统计学意义(均P0.05)。2.各组间右心结构的比较:各组间RA-D1、RA-D2的差异有统计学意义(均P0.01);RV-D在Ⅰ组与Ⅱ组间差异无统计学意义(P=0.213),在Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组间差异有统计学意义(均P0.01);RV-FW在Ⅱ组与Ⅲ组间的差异无统计学意义(P=0.069),在Ⅰ组与Ⅱ组、Ⅰ组与Ⅲ组间差异有统计学意义(均P0.01)。3.各组间RT-3DE参数之间的比较:RVEDV、RVESV在各组间测值的差异有统计学意义(均P0.01);RVEF在Ⅰ组与Ⅱ组、Ⅰ组与Ⅲ组之间差异有统计学意义(均P0.01),在Ⅱ组与Ⅲ组之间差异无统计学意义(P0.02);RVSV在Ⅰ组与Ⅲ组间有统计学意义(P0.01),在Ⅰ组与Ⅱ组、Ⅱ组与Ⅲ组之间差异无统计学意义(均P0.02)。4.各组间常规超声心动图参数之间的比较:TAPSE、RVFAC在各组间的差异均有统计学意义(均P0.01);RIMP在Ⅰ组与Ⅱ组、Ⅰ组与Ⅲ组之间差异有统计学意义(均P0.01),在Ⅱ组与Ⅲ组之间差异无统计学意义(P0.02);S’在Ⅰ组与Ⅲ组间差异有统计学意义(P0.01),在Ⅰ组与Ⅱ组、Ⅱ组与Ⅲ组之间差异无统计学意义(均P0.02)。5.相关性研究:整体RVEDV、RVESV、RVEF、RIMP、S’、TAPSE、RVFAC与PASP的相关系数分别为0.744、0.822、-0.861、0.602、-0.334、-0.621、-0.725(均P0.01),RVEF与RIMP、S’、TAPSE、RVFAC的相关系数分别为:-0.707、0.402、0.574、0.763(均P0.01)。I组中RVEF与RIMP、S’、TAPSE、RVFAC的相关系数分别为:-0.68、0.575、0.728、0.787(均P0.01);Ⅱ组中RVEF与以上参数的相关系数分别为:-0.679、0.39、0.672、0.631(均P0.01);III组中RVEF与以上参数的相关系数分别为:-0.559、0.369、0.661、0.744(均P0.01)。6.重复性研究:同一观察者测得的RVEF平均差异为(0.22±2.1)%,组内相关系数为0.897,Blant-Altman图也显示重复测量的RVEF与均值呈一致性的变化趋势。结论1.随着PASP的增高,右室容积逐渐增加而收缩功能逐渐减低。2.RT-3DE技术可客观、准确的评价中、重度PAH患者的右室容积和射血分数,可为临床提供准确的参考依据。3.三维RVEF与常规超声心动图参数的相关性从高到低依次为RVFAC、RIMP、TAPSE、S’,在评估正常人和中、重度PAH患者的右室收缩功能时,最可靠的常规超声心动图参数分别为RVFAC、RIMP、RVFAC。
[Abstract]:The purpose of the application of real-time three-dimensional echocardiography (real time three-dimensional echocardiography RT-3DE) technology for quantitative measurement of severe pulmonary arterial hypertension (pulmonary, hypertension, PAH) in patients with right ventricular volume and ejection fraction, and the conventional echocardiographic parameters were compared between the study aims to explore the clinical value of RT-3DE technique in the assessment of systolic function patients with severe PAH right ventricular, and conventional echocardiography can find reliable indicators of different degrees of PAH right ventricular systolic function in patients with sensitive parameter in the evaluation chart. Methods 30 healthy volunteers as control group (group I), diagnosed in severe PAH patients 25 cases, divided into moderate group (Group II, 50mmHgPASP = 70mmHg), severe group (group PASP70mmHg). General: to measure and record each subject's age, height, weight, heart rate. The conventional echocardiographic parameters: using M5S probe, Were measured and recorded right atrial diameter (right atrial left and right diameter, RA-D1), right atrial diameter (right atrial on upper and lower diameter, RA-D2), right ventricular basal diameter (right ventricular basal diameter, RV-D), right ventricular wall thickness (right ventricular free wall thickness three, RV-FW), tricuspid regurgitation velocity (the max maximum regurgitant velocity, V), estimation of pulmonary artery systolic pressure (pulmonary artery systolic pressure, PASP), right ventricular fractional area change (right, ventricular fractional, area change, RVFAC), three tricuspid annular peak systolic velocity (tricuspid annular systolic peak velocity, S "), right ventricular work index (right ventricular myocardial performance index, RIMP), three tricuspid annular systolic displacement (tricuspid annular systolic displacement, TAPSE). Real time 3D echocardiography The dynamic parameters: application of 4V probe, continuous acquisition of 3 cardiac cycles of right ventricular dynamic 3D model and stored into the Echo PAC workstation, 4D enabled Auto RVQ program, the final draw right ventricular end diastolic volume (right ventricular end diastolic volume, RVEDV), right ventricular systolic volume (right ventricular systolic volume, RVESV), right ventricular stroke volume (right ventricular stroke volume, RVSV) and right ventricular ejection fraction (right ventricular ejection fraction, RVEF). The application of RT-3DE technology to assess the reproducibility of the right ventricular systolic function were analyzed, and the 3 groups of the above parameters, probes the trend of each parameter with the increase of PASP, and the analysis between the parameters and the PASP parameters of RVEF and S, three ', RIMP, TAPSE, correlation between RVFAC. Results of the 1. general situation: group participants' age, heart rate, body weight, height difference had no statistical meaning 涔，

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