应用二维应变评估藏区动脉导管未闭患儿介入前后心肌收缩功能
发布时间：2018-08-04 13:33
【摘要】：目的：应用二维应变及应变率成像技术对高海拔缺氧的西藏地区动脉导管未闭患儿在接受导管微创介入治疗前后，对其左、右心室心肌收缩功能进行定量分析，以期了解高原低氧环境下动脉导管未闭儿童心肌收缩水平及介入术后短期内心肌收缩功能的恢复程度。 方法：西藏地区动脉导管未闭（Patent ductus arteriosus,PDA）患儿共31例，其中男11例，女20例，平均年龄8.52±3.00岁，平原地区动脉导管未闭(PDA)患儿共33例，其中男14例，女19例，平均年龄7.70±3.19岁，选择年龄、性别相匹配的同期因其他疾病在我院住院接受治疗或正常查体的儿童共20例为正常组,其中男10例，女10例，平均年龄8.50±2.46岁。采用美国GE公司生产的Vivid7彩色多普勒超声检查仪器，三组儿童入选后常规查身高、体重、血压、心率。PDA患儿于术前1日及术后7日在血流动力稳态情况下行超声心动图检查，正常组儿童入选后行超声心动图检查，三组儿童分别利用连续多普勒技术测量肺动脉收缩压（PASP）。取二维超声左心室长轴切面及心尖四腔切面，心尖四腔切面连续采集3个心动周期后导入EchoPAC7.0分析软件，心肌节段收缩功能测定包括：PDA患儿分别将术前及术后标准心尖四腔切面图导入分析软件后，定帧于收缩末期，先手动勾勒右心室心内膜，将右室游离壁及室间隔各划分为三个节段，测量其心肌收缩期峰值纵向应变（Endsystolic longitudinal strain SL），再手动勾勒左心室心内膜，测量左心室游离壁三个节段心肌应变及应变率，分别测量三次取平均值。再将正常组儿童心尖四腔切面图像导入软件重复上述过程进行分析。其中藏区PDA患儿通过二维测量其左心室舒张末期左右径（LVEDd）及右心室舒张末期左右径（RVEDd）。Simpson法利用公式计算其左室舒张末期容积（LVEDV）及右室舒张末期容积（RVEDV），计算左心室射血分数（LVEF），右心室射血分数（RVEF），左心室每搏输出量（LVSV），每分输出量（LVCO），心指数（CI），左室质量指数（LVMI）及左室容积指数(LVEDVI)。数值采用SPSS16.0统计分析软件进行分析处理。 结果： 1.一般资料比较藏区组与平原组PDA患儿及正常组儿童在年龄、性别、体重、血压、心率无统计学差异（P0.05），藏区组患儿身高较平原组及正常组低（P0.01）。藏区组未闭动脉导管的最窄处直径较平原组宽（P0.01），肺动脉压力较平原组及正常组高（P0.01）。 2.藏区患儿心室形态功能变化比较藏区患儿手术前及手术后7天超声心动图测量，术后较术前左心室舒张末径(LVEDd)缩短（P0.01），左心室舒张末期容积(LVEDV)缩小（P0.01）；左心室射血分数（LVEF）减低，但无统计学差异（P0.05），左心室每搏输出量（SV）、每分输出量（CO）、心指数（CI）、左室质量指数（LVMI）、左心室舒张末期容积指数（LVEDVI）均减低（P0.01）。术后右心室舒张末径(RVEDd)较术前增加（P0.01），右心室舒张末期容积(RVEDV)增大（P0.01），右心室射血分数（RVEF）提高，但无显著性差异（P0.05）。肺动脉收缩压较术前降低（P0.01）。 3.心肌应变及应变率比较 3.1藏区组介入术后一周左心室游离壁基底段、中间段、心尖段三个节段应变较术前减低（P0.01）；室间隔基底段及中间段、右室游离壁基底段、中间段应变较术前增加（P0.01），右室游离壁心尖段应变较术前增加（P0.05），而室间隔心尖段应变虽较术前增加，但无统计学差异（P0.05）。藏区组术后应变率较术前在左室游离壁基底段、中间段、心尖段均减低，（P0.01），室间隔三个节段应变率较术前增加，但无统计学差异（P0.05），右室游离壁三个节段应变率均较术前增加，其中基底段无统计学意义（P0.05），中间段（P0.05），心尖段（P0.01）。 3.2术前藏区组左室游离壁三个节段应变高于正常组，其中左室游离壁基底段（P0.05），左室游离壁中间段、心尖段（P0.01）；室间隔基底段、中间段及心尖段，右室游离壁三个节段应变均低于正常组，其中室间隔中间段无统计学差异（P0.05），室间隔基底段、心尖段（P0.05），右室游离壁三个节段（P0.01）。而术后一周藏区患儿左室游离壁三个节段及室间隔三个节段与正常组无统计学差异（P0.05），右室游离壁三个节段应变仍低于正常组（P0.01）。 3.3藏区组与平原组介入前在左室游离壁三个节段、室间隔三个节段两组应变值无明显差异，均无统计学意义（P0.05），右室游离壁三个节段藏区组低于平原组，其中基底段、中间段（P0.01），心尖段（P0.05）。藏区组与平原组两组患儿术前与术后应变变化值在左室游离壁基底段、中间段、心尖段，室间隔基底段、中间段、心尖段及右室游离壁基底段及心尖段八个节段比较两组应变改变值，均无统计学差异（P0.05），，仅右室游离壁中间段藏区组的改变大于平原组（P0.05）。 结论： 1、藏区患儿介入手术后短期内左室心肌收缩功能可恢复至正常水平，而右室心肌收缩运动及肺动脉压力短期内仍不能恢复至正常水平。二维应变技术可无创、定量评估心肌的收缩功能。 2、西藏地区PDA患儿肺动脉压力及右室心肌收缩功能较平原地区患儿受累更加明显，而左室心肌收缩功能与平原地区无异。高原PDA介入术后心肌收缩程度的变化与平原地区总体无明显区别。
[Abstract]:Objective: to analyze the systolic function of left and right ventricular myocardium in children with patent ductus arteriosus in Tibet area with high altitude hypoxia before and after minimally invasive interventional therapy with two dimensional strain and strain rate imaging technique, in order to understand the myocardial contractile level and the short post intervention in children with patent ductus arteriosus under high altitude hypoxia. The degree of recovery of the heart muscle contractile function.
Methods: there were 31 children with Patent ductus arteriosus (PDA) in Tibet, including 11 males and 20 females, with an average age of 8.52 + 3 years. There were 33 cases of patent ductus arteriosus (PDA) in the plain area, including 14 men and 19 women. The average age was 7.70 + 3.19 years, and the age was selected and the sex phase matched the other diseases in our hospital. 20 children who received treatment or normal physical examination were normal group, including 10 male and 10 female, with an average age of 8.50 + 2.46 years. The Vivid7 color Doppler ultrasonic examination instruments produced by GE company were used. The three groups of children were examined for stature, body weight, blood pressure and heart rate.PDA at 1 days before and 7 days after operation. In the downlink echocardiography, the children of the normal group were examined by echocardiography. The three groups of children were measured by continuous Doppler technique to measure the systolic pressure of the pulmonary artery (PASP). The two dimensional echocardiography of the left ventricular long axis and the four cavities of the apex were taken, and the 3 cardiac cycles were collected continuously after the four cavities of the apical four cavities, and the EchoPAC7.0 analysis software was introduced. The measurement of segmental systolic function included: after introducing the analysis software before and after the standard apex four cavities, the PDA children set the frame at the end of the systole, first manually outlined the right ventricular endocardium, and divided the right ventricular free wall and the ventricular septum into three segments, and measured the peak systolic peak longitudinal strain of the myocardium (Endsystolic longitudinal strain S). L), the left ventricular endocardium was manually outlined, and the myocardial strain and strain rate of the left ventricular free wall were measured at the three segment of the left ventricular wall, and the mean values were measured three times respectively. Then the normal group of children's apical four cavity section images were introduced to repeat the process. The left ventricular end diastolic diameter (LVEDd) and the left ventricular diastolic diameter (LVEDd) of the children in the Tibetan area of PDA were measured by two dimension. The right ventricular end diastolic diameter (RVEDd).Simpson method was used to calculate the left ventricular end diastolic volume (LVEDV) and right ventricular end diastolic volume (RVEDV). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), left ventricular stroke output (LVSV), per minute output (LVCO), cardiac index (CI), left ventricular mass index (LVMI) and left ventricle were calculated. Volume index (LVEDVI). Numerical analysis was carried out by SPSS16.0 statistical analysis software.
Result:
1. the general data showed that there was no significant difference in age, sex, weight, blood pressure and heart rate (P0.05) between the Tibetan group and the plain group PDA children and the normal group (P0.05). The height of the children in the Tibetan group was lower than that in the plain group and the normal group (P0.01). The narrowest diameter of the patent ductus arteriosus in the Tibetan group was wider than the plain group (P0.01), and the pulmonary arterial pressure was higher than that in the plain group and the normal group (P 0.01).
2. the ventricular morphological and functional changes in children in Tibetan children were compared before and 7 days after surgery in Tibetan children. The left ventricular end diastolic diameter (LVEDd) was shortened (P0.01), left ventricular end diastolic volume (LVEDV) decreased (P0.01) and left ventricular ejection fraction (LVEF) decreased, but there was no statistical difference (P0.05), and left ventricular stroke output (S). V), the heart index (CI), the left ventricular mass index (LVMI) and the left ventricular end diastolic volume index (LVEDVI) decreased (P0.01). The right ventricular end diastolic diameter (RVEDd) after operation was increased (P0.01), the right ventricular end diastolic volume (RVEDV) increased (P0.01), and the right ventricular ejection fraction (RVEF) increased, but there was no significant difference (P0.05). Pulmonary artery (P0.05). The systolic pressure was lower than that before the operation (P0.01).
3. comparison of myocardial strain and strain rate
3.1 the three segments of the left ventricular free wall basal segment, the middle segment and the apical segment were lower than those before the operation (P0.01), the basal segment and the middle segment of the ventricular septum, the right ventricular free wall basal segment, the middle segment strain increased (P0.01) and the apical apical strain of the right ventricle increased (P0.05), while the apical apex strain was in the ventricular septum, although the strain of the apex in the ventricular septum was higher than that before the operation. Compared with pre operation, there was no statistical difference (P0.05). The strain rate of the Tibetan group after operation was lower than that before operation in the basal segment of the left ventricular wall, the middle segment and the apical segment (P0.01), and the strain rate of the three segments of the interventricular septum increased compared with that before the operation, but there was no statistical difference (P0.05). The strain rates of the three segments of the right ventricular wall were all higher than those before the operation, and the basal segment was not statistically significant. Learning meaning (P0.05), middle segment (P0.05), apical segment (P0.01).
3.2 the three segment strain of left ventricular free wall in the Tibetan group was higher than that of the normal group. The left ventricular free wall basal segment (P0.05), the left ventricular free wall middle segment, the apex segment (P0.01), the interventricular septum basal segment, the middle segment and the apex segment, the right ventricular free wall were all lower than the normal group, and there was no statistical difference between the interventricular septum (P0.05) and the interventricular septum (P0.05). The basal segment, the apical segment (P0.05) and the right ventricular free wall were three segments (P0.01). There was no statistical difference between the three segments of the left ventricular wall and the three segments of the ventricular septum in the left ventricular wall of the children in one week after the operation (P0.05), and the three segments of the free wall of the right ventricle were still lower than those of the normal group (P0.01).
3.3 there were no significant differences between the three segments of the left ventricular free wall and the three segments of the ventricular septum before the intervention of the Tibetan group and the plain group, and there was no significant difference between the two groups of the ventricular septum three segments (P0.05), and the three segments of the right ventricular free wall group were lower than the plain group, including the basal segment, the middle segment (P0.01) and the apex segment (P0.05). The two groups of children in the Tibetan and plain groups should be before and after the operation. In the left ventricular free wall basal segment, the middle segment, the apex segment, the interventricular septum basal segment, the middle segment, the apex segment, the right ventricular free wall basal segment and the apex segment eight segments, there was no statistical difference (P0.05), but the changes in the middle segment of the right ventricular free wall group were more than that of the plain group (P0.05).
Conclusion:
1, the left ventricular systolic function of the children in the Tibetan area can be restored to normal level in the short term, while the right ventricular systolic movement and pulmonary artery pressure can not recover to the normal level in the short term. The two-dimensional strain technique can not be created and quantified the systolic function of the myocardium.
2, the pulmonary arterial pressure and right ventricular systolic function of the children with PDA in Tibet were more obvious than those in the plain, but the systolic function of the left ventricular myocardium was not the same as that in the plain. The changes of myocardial contractility after PDA intervention at high altitude were not significantly different from those in the plain.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4
[Abstract]:Objective: to analyze the systolic function of left and right ventricular myocardium in children with patent ductus arteriosus in Tibet area with high altitude hypoxia before and after minimally invasive interventional therapy with two dimensional strain and strain rate imaging technique, in order to understand the myocardial contractile level and the short post intervention in children with patent ductus arteriosus under high altitude hypoxia. The degree of recovery of the heart muscle contractile function.
Methods: there were 31 children with Patent ductus arteriosus (PDA) in Tibet, including 11 males and 20 females, with an average age of 8.52 + 3 years. There were 33 cases of patent ductus arteriosus (PDA) in the plain area, including 14 men and 19 women. The average age was 7.70 + 3.19 years, and the age was selected and the sex phase matched the other diseases in our hospital. 20 children who received treatment or normal physical examination were normal group, including 10 male and 10 female, with an average age of 8.50 + 2.46 years. The Vivid7 color Doppler ultrasonic examination instruments produced by GE company were used. The three groups of children were examined for stature, body weight, blood pressure and heart rate.PDA at 1 days before and 7 days after operation. In the downlink echocardiography, the children of the normal group were examined by echocardiography. The three groups of children were measured by continuous Doppler technique to measure the systolic pressure of the pulmonary artery (PASP). The two dimensional echocardiography of the left ventricular long axis and the four cavities of the apex were taken, and the 3 cardiac cycles were collected continuously after the four cavities of the apical four cavities, and the EchoPAC7.0 analysis software was introduced. The measurement of segmental systolic function included: after introducing the analysis software before and after the standard apex four cavities, the PDA children set the frame at the end of the systole, first manually outlined the right ventricular endocardium, and divided the right ventricular free wall and the ventricular septum into three segments, and measured the peak systolic peak longitudinal strain of the myocardium (Endsystolic longitudinal strain S). L), the left ventricular endocardium was manually outlined, and the myocardial strain and strain rate of the left ventricular free wall were measured at the three segment of the left ventricular wall, and the mean values were measured three times respectively. Then the normal group of children's apical four cavity section images were introduced to repeat the process. The left ventricular end diastolic diameter (LVEDd) and the left ventricular diastolic diameter (LVEDd) of the children in the Tibetan area of PDA were measured by two dimension. The right ventricular end diastolic diameter (RVEDd).Simpson method was used to calculate the left ventricular end diastolic volume (LVEDV) and right ventricular end diastolic volume (RVEDV). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), left ventricular stroke output (LVSV), per minute output (LVCO), cardiac index (CI), left ventricular mass index (LVMI) and left ventricle were calculated. Volume index (LVEDVI). Numerical analysis was carried out by SPSS16.0 statistical analysis software.
Result:
1. the general data showed that there was no significant difference in age, sex, weight, blood pressure and heart rate (P0.05) between the Tibetan group and the plain group PDA children and the normal group (P0.05). The height of the children in the Tibetan group was lower than that in the plain group and the normal group (P0.01). The narrowest diameter of the patent ductus arteriosus in the Tibetan group was wider than the plain group (P0.01), and the pulmonary arterial pressure was higher than that in the plain group and the normal group (P 0.01).
2. the ventricular morphological and functional changes in children in Tibetan children were compared before and 7 days after surgery in Tibetan children. The left ventricular end diastolic diameter (LVEDd) was shortened (P0.01), left ventricular end diastolic volume (LVEDV) decreased (P0.01) and left ventricular ejection fraction (LVEF) decreased, but there was no statistical difference (P0.05), and left ventricular stroke output (S). V), the heart index (CI), the left ventricular mass index (LVMI) and the left ventricular end diastolic volume index (LVEDVI) decreased (P0.01). The right ventricular end diastolic diameter (RVEDd) after operation was increased (P0.01), the right ventricular end diastolic volume (RVEDV) increased (P0.01), and the right ventricular ejection fraction (RVEF) increased, but there was no significant difference (P0.05). Pulmonary artery (P0.05). The systolic pressure was lower than that before the operation (P0.01).
3. comparison of myocardial strain and strain rate
3.1 the three segments of the left ventricular free wall basal segment, the middle segment and the apical segment were lower than those before the operation (P0.01), the basal segment and the middle segment of the ventricular septum, the right ventricular free wall basal segment, the middle segment strain increased (P0.01) and the apical apical strain of the right ventricle increased (P0.05), while the apical apex strain was in the ventricular septum, although the strain of the apex in the ventricular septum was higher than that before the operation. Compared with pre operation, there was no statistical difference (P0.05). The strain rate of the Tibetan group after operation was lower than that before operation in the basal segment of the left ventricular wall, the middle segment and the apical segment (P0.01), and the strain rate of the three segments of the interventricular septum increased compared with that before the operation, but there was no statistical difference (P0.05). The strain rates of the three segments of the right ventricular wall were all higher than those before the operation, and the basal segment was not statistically significant. Learning meaning (P0.05), middle segment (P0.05), apical segment (P0.01).
3.2 the three segment strain of left ventricular free wall in the Tibetan group was higher than that of the normal group. The left ventricular free wall basal segment (P0.05), the left ventricular free wall middle segment, the apex segment (P0.01), the interventricular septum basal segment, the middle segment and the apex segment, the right ventricular free wall were all lower than the normal group, and there was no statistical difference between the interventricular septum (P0.05) and the interventricular septum (P0.05). The basal segment, the apical segment (P0.05) and the right ventricular free wall were three segments (P0.01). There was no statistical difference between the three segments of the left ventricular wall and the three segments of the ventricular septum in the left ventricular wall of the children in one week after the operation (P0.05), and the three segments of the free wall of the right ventricle were still lower than those of the normal group (P0.01).
3.3 there were no significant differences between the three segments of the left ventricular free wall and the three segments of the ventricular septum before the intervention of the Tibetan group and the plain group, and there was no significant difference between the two groups of the ventricular septum three segments (P0.05), and the three segments of the right ventricular free wall group were lower than the plain group, including the basal segment, the middle segment (P0.01) and the apex segment (P0.05). The two groups of children in the Tibetan and plain groups should be before and after the operation. In the left ventricular free wall basal segment, the middle segment, the apex segment, the interventricular septum basal segment, the middle segment, the apex segment, the right ventricular free wall basal segment and the apex segment eight segments, there was no statistical difference (P0.05), but the changes in the middle segment of the right ventricular free wall group were more than that of the plain group (P0.05).
Conclusion:
1, the left ventricular systolic function of the children in the Tibetan area can be restored to normal level in the short term, while the right ventricular systolic movement and pulmonary artery pressure can not recover to the normal level in the short term. The two-dimensional strain technique can not be created and quantified the systolic function of the myocardium.
2, the pulmonary arterial pressure and right ventricular systolic function of the children with PDA in Tibet were more obvious than those in the plain, but the systolic function of the left ventricular myocardium was not the same as that in the plain. The changes of myocardial contractility after PDA intervention at high altitude were not significantly different from those in the plain.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4
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1 ;常见先天性心脏病介入治疗中国专家共识 五、先天性心脏病复合畸形的介入治疗[J];介入放射学杂志;2011年05期
2 郭炜华;史旭波;王国宏;吴明营;陈波;王雷;刘君;陈U
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