组织多普勒技术检测主动脉瓣环运动评估主动脉瓣置换术后左心室整体功能改变

发布时间：2018-02-02 01:16

本文关键词： 主动脉瓣环超声心动图瓣膜置换术左心室功能组织多普勒　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景主动脉瓣病变包括主动脉瓣狭窄和主动脉瓣关闭不全,是最常见的心脏瓣膜病变之一。主动脉病变程度的加剧必然会导致血流动力学的改变进而影响左室心肌引发心功能的改变。临床上,主动脉瓣置换术(aortic valve replacement, AVR)治疗主动脉瓣病变的常用手术.超声心动图是AVR术后临床标准评估工具,能够安全准确地检测、分析主动脉瓣及心功能等指标。虽然超声心动图各类技术的迅猛发展,但对设备、技术、人员等均有很高的要求,因此在临床应用受到一定的限制。组织多普勒成像技术(tissue Doppler imaging, TDI)在临床常见,简便易行,又能有效的反映心肌运动速度和方向、局部结构运动,可精确分析心室壁及瓣环运动状态,观察心功能的改变。瓣环作为心脏结构的一部分,TDI可检测到瓣环运动的改变。众所周知,二尖瓣环运动指标已被广泛应用于左心室局部和整体功能的评估。而相对来说国内外主动脉瓣环运动研究较少,其检测指标也不全面,本文就此TDI检测主动脉瓣环运动做了相关研究,发现用组织多普勒检测主动脉瓣环运动可作为主动脉瓣置换术后评估左心室整体功能的指标。目的：探讨组织多普勒技术检测主动脉瓣环运动在评估主动脉瓣置换术后患者左心室整体功能方面的临床价值。方法：选取2014年3月-2014年5月我院主动脉瓣膜置换术后患者20例和20例健康体检者(对照组)进行研究,于TDI模式下获取心尖五腔切面(A5C)和心尖三腔切面(A3C)测定主动脉瓣环4个壁的组织速度,测量收缩期峰速(AASa)、舒张早期峰速(AAEa)、舒张晚期峰速(AAAa)。结果：主动脉瓣置换术后患者与体检对照组比较,主动脉瓣置换术后患者ARD、AO、 HR, E无显著改变(P0.05),而IVSd、LVPWd、LVIDd、LVIDs、A、E/Ea、Tei指数显著升高(P0.05),主动脉瓣环TDI参数均显著减低(P0.001)。相关性分析显示,EF、Tei指数显著负相关(r=-0.514,P=0.001)。主动脉瓣环TDI各参数均与Tei指数显著负相关(P0.01),主动脉瓣环TDI参数SR、AR、AL、AA、 SP、AP与LVEF呈正相关,ER、SL、EL、SA、EA、EP与LVEF无相关性。结论：主动脉瓣置换术后患者主动脉瓣环运动明显降低,术后左心室功能LVEF明显降低,E/Ea、Tei指数升高,与LVEF相比,主动脉瓣环TDI参数能更好的反映Tei指数的改变。主动脉瓣环运动检测为评价主动脉瓣置换术后左心室整体功能改变提供了新的方法。
[Abstract]:Research background. Aortic valve disease includes aortic stenosis and aortic valve insufficiency. It is one of the most common heart valve diseases. The severity of aortic disease will inevitably lead to hemodynamic changes, thereby affecting the left ventricular myocardium to cause cardiac function changes. Aortic valve replacement (AVR) is a common surgical procedure for the treatment of aortic valve disease. Echocardiography is a standard clinical evaluation tool after AVR, and can be detected safely and accurately. Analysis of aortic valve and cardiac function. Although the rapid development of echocardiography technology, but the equipment, technology, personnel and so on have very high requirements, Therefore, the clinical application of tissue Doppler imaging (TDI) is limited to some extent. Tissue Doppler imaging (TDI) is common in clinical practice, and can effectively reflect the velocity and direction of myocardial movement, local structural movement. It can accurately analyze the motion state of ventricular wall and annulus and observe the changes of cardiac function. As a part of cardiac structure, TDI can detect the changes of valvular motion. Mitral annular motion indices have been widely used in the assessment of left ventricular regional and global function. In this paper, TDI was used to detect aortic annular motion. It was found that the detection of aortic annular motion by tissue Doppler could be used as an index to evaluate the global function of left ventricle after aortic valve replacement. Objective:. To evaluate the clinical value of tissue Doppler technique in assessing the global left ventricular function after aortic valve replacement. Methods:. From March 2014 to May 2014, 20 patients with aortic valve replacement in our hospital and 20 healthy people (control group) were studied. The tissue velocities of the four walls of the aortic annulus were measured by A5C and A3C. the peak systolic velocities of the aortic annulus were measured, the peak velocities of the early diastole and the late diastolic peak velocities were measured, and the end diastolic peak velocities of the aortic annulus were also measured. Results:. Compared with the control group after aortic valve replacement, After aortic valve replacement, there was no significant change of AOA, HRE, E in patients with aortic valve replacement, but there was no significant change in APA, HRE and E in patients undergoing aortic valve replacement, while there was a significant increase in the TDI index of LVIDsU / EaTei, and a significant decrease in the TDI parameters of aortic annulus. The correlation analysis showed that there was a significant negative correlation between TDI parameters of aortic annulus and Tei (r = -0. 514 P0. 001, P = 0. 001, P = 0. 001, P = 0. 001, P = 0. 05, P = 0. 001, P = 0. 05, P = 0. 05, P = 0. 001). There was a significant negative correlation between TDI parameters of aortic annulus and LVEF. There was no correlation between LVEF and LVEF. Conclusion:. After aortic valve replacement, the aortic annular movement decreased significantly, and the left ventricular function LVEF decreased significantly after aortic valve replacement. Compared with LVEF, the LVEF index of left ventricular function decreased significantly. The TDI parameters of aortic annulus can better reflect the change of Tei index. The measurement of aortic annulus motion provides a new method for evaluating the changes of global left ventricular function after aortic valve replacement.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R445.1

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