斑点追踪成像评价阻塞性睡眠呼吸暂停低通气综合征患者左房功能

发布时间：2018-03-06 23:16

本文选题：左心房　切入点：阻塞性睡眠呼吸暂停综合征　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的中老年人中阻塞性睡眠呼吸暂停综合征(OSAHS)发病率较高,能导致睡眠呼吸紊乱,且具有潜在致死性。本研究旨在通过斑点追踪成像(STI),对患有和不患有OSAHS研究对象的左心房功能进行比较,得出左房纵向心肌功能在OSAHS患者和健康个体的区别。证明使用STI评估该类患者左心房功能,可以早期发现左房的重构和损伤,是一种安全有效的新途径。方法将120例人群纳入本次研究,其中包含90例OSAHS患者和30例健康对照组。所有受检者都要做多导睡眠呼吸检测和超声心动图并进行斑点追踪成像,并根据呼吸暂停低通气指数(AHI)结果将OSAHS患者进行轻度(AHI 5~15),中度(16~30)和重度(AHI30)分组。在屏气状态下获取连续3个心动周期的心尖两腔、心尖四腔动态图像并存储。使用二维、M超、彩色多普勒、组织多普勒技术测量左室室间隔厚度(IVSd)及后壁厚度(LVPWd)、左室舒张末内径(LVEDD)、等容舒张时间(IVRT)、左室射血分数(LVEF)、二尖瓣口血流频谱的E峰、A峰和E峰减速时间(Dec T)、二尖瓣舒张早期峰值速度(E)和二尖瓣环舒张早期心肌速度(E/)之间的比值。计算左室质量指数(LVMI)。在心尖四腔和两腔切面,利用面积-长度法获得左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩期容积(LAVprep)并记录。使用左房容积除以体表面积计算出左房最大容积指数(LAVImax)、左房最小容积指数(LAVImin)、左房收缩前容积指数(LAVIprep)。再根据相关公式计算出左心房总的排空分数(LATEF)、被动排空分数(LAPEF)、主动排空分数(LAAEF)和膨胀指数(LAEI)。将动态图像传输至Q-LAB9.0软件进行离线分析,利用斑点追踪技术获得左房应变及应变率曲线,记录左室收缩期、舒张早期及舒张晚期左房应变(LA_(S-S)、LA_(S-E)、LA_(S-A))及应变率(LA_(SR-S)、LA_(SR-E)、LA_(SR-A))。结果 IVSd及LVPWd自中度组开始增加,OSAHS重度组与健康对照组比较LVMI、IVRT、Dec T有统计学差异(P0.05)。E/E/在中度组和重度组高于对照组和轻度组,重度组增加更明显(P0.05)。与对照组相比,OSAHS患者组的LAVI_(max)、LAVI_(prep)、LAVI_(min)都明显增加,LAPEF减低LAAEF增高(P0.05)。LA_(S-E)、LA_(SR-E)和LA_(S-S)、LA_(SR-S)随着OSAHS严重程度的增加而减低(P0.05),LA_(S-A)、LA_(SR-A)在中度组轻微升高,而重度组的OSAHS患者LA_(S-A)、LA_(SR-A)降低(P0.05),但与健康对照组相比增高。左房应变和应变率检查者内变异系数-0.392~0.064,-0.188~0.019,检查者间变异系数为-0.257~0.039,-0.392~0.621。结论 OSAHS能增加左心的负担,导致舒张功能减退,早期可导致左心房重构,影响左房功能。应用斑点追踪成像对左房功能进行详细的评估,在亚临床阶段就可以发现患有OSAHS人群的左房重构和损伤,可以作为一种评估左房功能安全有效的可重复途径。
[Abstract]:Objective the incidence of obstructive sleep apnea syndrome (OSAHS) in middle and old people is high, which can lead to sleep apnea disorder. The purpose of this study was to compare left atrial function in subjects with and without OSAHS by speckle tracking imaging. The difference of left atrial longitudinal myocardial function between patients with OSAHS and healthy individuals is obtained. It is proved that using STI to assess left atrial function in such patients can detect early remodeling and injury of left atrium. The study included 90 patients with OSAHS and 30 healthy controls. All subjects underwent polysomnography, echocardiography and dot-tracking imaging. According to the results of apnea hypopnea index (AHII), the patients with OSAHS were divided into three groups: mild AHI _ (15), moderate AHI _ (16 ~ (30)) and severe AHI _ (30). The apical two-chamber and apical four-chamber dynamic images of three consecutive cardiac cycles were obtained and stored in breath-holding state. Color Doppler, Tissue Doppler technique for measuring left ventricular septal thickness (IVSd) and posterior wall thickness (LVPWdN), left ventricular end-diastolic diameter (LVEDDD), isovolumic diastolic time (IVRTT), left ventricular ejection fraction (LVEF), mitral valve flow spectrum (E peak A) and E peak deceleration time (TDec), mitral valve. The ratio between early diastolic peak velocity (E) and mitral annulus early diastolic velocity (E / P). The left ventricular mass index (LVMI) was calculated. The maximum volume of left atrium was obtained by using area-length method, the minimum volume of left atrium was obtained by LAVmax, the minimum volume of left atrium was determined by LAVmin, and the left atrial systolic volume was recorded. The maximum volume index of left atrium was calculated by dividing the area of left atrium by the area of body surface, and the minimum volume index of left atrium was calculated by LAVImaxn, the minimum volume index of left atrium and left atrial volume index were determined by the method of left atrial volume division. The left atrial total emptying fraction (LATEFA), passive emptying fraction (LAPEFA), active emptying fraction (LAAEFG) and expansion index (LAEI) were calculated according to the relative formula. The dynamic image was transmitted to Q-LAB9.0 software for offline analysis. The left atrial strain and strain rate curves were obtained by speckle tracing technique, and the left ventricular systolic period was recorded. Early diastolic and late diastolic left atrial strain (LAS / S) and strain rate (S / S) and strain rate (S / S / S / T). Results IVSd and LVPWd began to increase since the moderate group compared with the healthy control group. There was a significant difference in LVMIIVRTDec T between the moderate group and the control group (P0.05. EP / EP / EP / P / P / P / P / P). The results showed that IVSd and LVPWd were significantly higher in the moderate and severe groups than in the control group and the mild group. In the severe group, the increase was more obvious than that in the control group. In comparison with the control group, the number of LAVISCALVIX / LAVIIIMA / Lago / LAPEF / LAPEF / LAPEF / LAS / S / E / S / S / S / S / S / S / S / S / LASHS / S / S / S / S / LASHS / S / S / S / LASHS / S / S / LASA / S / LAPEF / LAPEF decreased significantly in the patients with OSAHS as compared with the control group, respectively. In the moderate group, there was a slight increase in the number of LAPEF and the increase in the number of LAAEF in the patients with OSAHS and the increase in the level of LAS-SLAA (SR-S-). In severe OSAHS group, LAS-A) decreased P0. 05%, but increased compared with the healthy control group. The coefficient of variation in left atrial strain and strain rate examination was 0. 392 ~ 0. 064 ~ 0. 188 卤0. 019, and the coefficient of variation was-0. 2577 ~ 0. 039-0. 3922 ~ 0. 621. Conclusion OSAHS can increase the burden of left heart and decrease diastolic function. Early left atrial remodeling can lead to left atrial remodeling, which affects left atrial function. Speckle tracing imaging is used to evaluate left atrial function in detail, and left atrial remodeling and injury can be detected in subclinical patients with OSAHS. It can be used as a repeatable way to evaluate the safety and effectiveness of left atrial function.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766;R540.45

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