组织多普勒成像用于评估脓毒症心室功能的临床研究

发布时间：2018-02-27 18:37

  本文关键词： 超声心动描记术 组织多普勒成像(TDI) 二尖瓣环运动速度 三尖瓣环运动速度 心功能 脓毒症 脓毒性休克　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的使用传统二维超声、组织多普勒成像(tissue Doppler imaging,TDI)监测正常人、脓毒症、脓毒性休克患者心室功能。方法将研究对象分为健康对照组(n=40)、脓毒症组(n=40)及脓毒性休克组(n=30),在入院24小时内先后进行传统二维超声、TDI检查。1.使用传统二维超声测量左室舒张末内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末内径(left ventricular end systolic diameter,LVESD)、左室射血分数(Ejection fraction,EF)、二尖瓣口舒张早期最大流速(early diastolic mitral blood flow peak velocity,E2)、二尖瓣口舒张晚期最大流速(late diastolic mitral blood flow peak velocity,A2),并计算E2/A2,右室舒张末内径(right ventricular end diastolic diameter,RVd)、右室收缩末内径(right ventricular end systolic diameter,RVs),三尖瓣口舒张早期最大流速(tricuspid valve early diastolic blood flow maximum velocity E3)、三尖瓣口舒张晚期最大流速(late diastolic tricuspid valve blood flow peak velocity A3),并计算E3/A3。2.完成传统传统二维超声参数后,进入TDI模式,测量二尖瓣环前叶收缩期峰值速度(systolic mitral annular peak velocity,Sm)、舒张早期峰值速度(early diastolic mitral annular peak velocity,Em)、舒张晚期峰值速度(late diastolic mitral annular peak velocity,Am),等容收缩时间(isovolumic contraction time,ICT)、等容舒张时间(isovolumic relaxation time,IRT)、射血时间(ejection time,ET),并计算左心心肌运动指数(left ventricular Myocardial performance index)LVMPI=(ICT+IRT)/ET;测量三尖瓣环中隔瓣收缩期峰值速度(tricuspid annular peak systolic velocity,s')、舒张早期峰值速度(early diastolic peak velocity,e')、舒张晚期峰值速度(late diastolic peak velocity,a'),等容收缩时间(ICT)、等容舒张时间(IRT)、射血时间(ET),并计算右心心肌运动指数RVMPI=(ICT+IRT)/ET。观察比较对照组、脓毒症组、脓毒性休克组在传统二维超声与组织多普勒成像下心功能超声参数的改变。结果1.传统经胸二维超声监测正常组、脓毒症和脓毒性休克心功能指标改变LVEDD、LVESD、LVEF、RVs、RVd在对照组(n=40,44.5±4.3mm、32.7±4.9mm、64.6±5.6、28.0±6.5mm、35.1±6.2mm)、脓毒症组(n=40,49.6±8.7mm、34.3±9.8mm、56.7±12.2、26.2±7.0mm、33.3±7.3mm)、脓毒性休克组(n=30,依次分别为46.1±9.3mm、30.0±7.9mm、60.3±10.0、29.7±5.2mm、27.4±5.1mm)无明显统计学差异(P0.05),E2/A2在脓毒性休克组(n=30,0.7±0.4)明显低于脓毒症组(n=40,0.9±0.3),脓毒症组(n=40,0.9±0.3)明显低于正常对照组(n=40,1.2±0.4),差异有统计学意义(P0.05),E3/A3在脓毒症组(n=40,0.8±0.6)、脓毒性休克组(n=30,0.6±0.80)明显低于对照组(n=40,1.3±0.7)(P0.05),2.TDI监测正常组、脓毒症和脓毒性休克心功能指标改变Am、E/Em、e'、a'、E/e'在脓毒性休克组(n=30,依次分别为8.4±1.6cm/s、10.6±4.6、9.5±4.3 cm/s、9.1±3.6 cm/s、8.6±3.1)、脓毒症组(n=40,7.2±2.4 cm/s、9.3±3.7、10.5±3.2cm/s、12.5±4.0 cm/s、8.2±2.5)、正常对照组(n=40,9.7±1.8 cm/s、6.3±2.5、10.8±2.4 cm/s、13.6±4.2 cm/s、7.5±1.9)比较,差异无统计学意义(P0.05);Sm、s'、Em/Am、e'/a'在脓毒性休克组(n=30,依次分别为6.8±4.2 cm/s、8.3±4.2 cm/s、0.6±0.3,0.7±0.6)明显低于脓毒症组(n=40,11.6±1.9 cm/s、12.1±4.8 cm/s、0.8±0.2,0.9±0.8),脓毒症组(n=40,11.6±1.9 cm/s、12.1±4.8 cm/s、0.8±0.2,0.9±0.8)明显低于正常对照组(n=40,13.5±1.7 cm/s、14.9±3.1 cm/s、1.1±0.4,1.1±0.5),差异有统计学意义(P0.05);LVMPI在脓毒性休克组(n=30,0.59±0.26)明显高于脓毒症(n=40,0.46±0.19)、脓毒症(n=40,0.46±0.19)明显高于对照组(n=40,0.39±0.23),差异有统计学意义(P0.05);RVMPI在脓毒症(n=40,0.58±0.12)、脓毒性休克组(n=30,0.56±0.16)较正常对照组(n=40,0.46±0.04)明显升高,差异有统计学意义(P0.05)。Em脓毒症(n=40,8.1±2.6cm/s)、脓毒性休克组(n=30,8.1±2.4 cm/s)较正常对照组(n=40,10.6±2.7 cm/s)明显降低,差异有统计学意义(P0.05)。结论1.传统二维超声测定左室射血分数在三组间无明显差异。2.TDI参数反映心肌收缩力改变较传统二维超声有优势,反映心肌收缩力TDI参数Sm、s'在脓毒症与脓毒性休克均存在显著性差异性改变。3.传统二维超声、TDI技术均可检测到脓毒症早期舒张功能改变。4.TDI具有发现脓毒症早期收缩、舒张功能改变的优点,具有潜在的临床应用价值,但仍需进一步大样本临床研究证实。
[Abstract]:The purpose of using the traditional two-dimensional echocardiography, Doppler tissue imaging (tissue Doppler, imaging, TDI) monitoring normal, sepsis, septic shock in patients with ventricular toxicity. Methods the subjects were divided into healthy control group (n=40), sepsis group (n=40) and septic shock group (n= 30), was 24 hours were conventional two-dimensional ultrasound, TDI examination and.1. using a conventional two-dimensional ultrasound measurement of left ventricular end diastolic diameter (left ventricular end diastolic diameter, LVEDD), left ventricular end systolic diameter (left ventricular end systolic diameter, LVESD), left ventricular ejection fraction (Ejection, fraction, EF), early diastolic velocity of mitral valve (early diastolic mitral blood flow peak velocity, E2), late diastolic peak velocity of mitral valve (late diastolic mitral blood flow peak velocity, A2), and calculate the E2/A2, right ventricular end diastolic diameter (right ventricular end diastol IC diameter, RVd), right ventricular end systolic diameter (right ventricular end systolic diameter, RVs), three tricuspid valve mouth early diastolic maximum velocity (tricuspid valve early diastolic blood flow maximum velocity E3), three tricuspid valve port late diastolic maximum velocity (late diastolic tricuspid valve blood flow peak velocity A3), and calculate the E3/A3.2. complete the traditional two-dimensional ultrasound parameters, enter TDI mode, the anterior lobe of mitral annulus peak systolic velocity (systolic mitral annular peak velocity, Sm), early diastolic peak velocity (early diastolic mitral annular peak velocity, Em), late diastolic peak velocity (late diastolic mitral annular peak velocity, Am), isovolumic contraction time (isovolumic contraction time, ICT), isovolumic relaxation time (isovolumic relaxation, time, IRT), ejection time (ejection, time, ET), and calculate the left heart muscle. Dynamic index (left ventricular Myocardial performance index) LVMPI= (ICT+IRT) /ET; three measurement of tricuspid annular peak systolic velocity (tricuspid septum flap annular peak systolic velocity, S'), early diastolic peak velocity (early diastolic peak velocity, E'), late diastolic peak velocity (late diastolic peak velocity, A'), isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), and calculate the right ventricular myocardial performance index RVMPI= (ICT+IRT) /ET. were compared between control group, sepsis group and septic shock group in the conventional echocardiography and tissue Doppler imaging in cardiac function under ultrasound parameters change. Results 1. the traditional transthoracic two-dimensional ultrasound monitoring in normal group, sepsis and septic shock index of heart function change of LVEDD, LVESD, LVEF, RVs, RVd in the control group (n=40,44.5 + 4.3mm, 32.7 + 4.9mm, 64.6 + 5.6,28.0 + 6.5mm, 35.1 + 6.2mm), sepsis group (n=40 ,49.6卤8.7mm,34.3卤9.8mm,56.7卤12.2,26.2卤7.0mm,33.3卤7.3mm),鑴撴瘨鎬т紤鍏嬬粍(n=30,渚濇�″垎鍒�涓，

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