应用超声技术对维持性血液透析患者心脏—血管耦联的研究

发布时间：2018-03-10 06:24

本文选题：超声技术　切入点：维持血液透析　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的应用超声射频信号血管内中膜分析(QIMT)、血管硬度定量分析（QAS）及心肌应变及应变率成像分析（XStrain）技术研究维持性血液透析患者心脏-血管耦联(VAC）。方法选择在我院维持性血液透析患者70例，按透析过程中有无低血压的发生将透析组患者分为透析低血压组33例和非低血压组37例，另选取30例身体健康者为对照组，分别接受心脏及血管超声检查，获取颈总动脉内中膜厚度（IMT）、僵硬度系数α、β、脉搏波速度（PWV）、左室射血分数（LVEF）、左心室间隔厚度（IVST）、心输出量（CO）、每搏输出量（SV）、左室收缩末期容积（LVESV），并计算获得心脏-血管耦联指标（VAC）；获取左心室基底段应变（LVSba）、中段应变（LVSpm）、心尖段应变（LVSap）。结果 1.血管超声与对照组相比较，透析组血管僵硬度参数PWV、α、β均增高（P0.05）；透析低血压组较非低血压组增高更为显著（P0.05）。IMT在三组间无统计学差异（P0.05）。 2.心脏超声与对照组相比较，透析组LVEF、CO、SV、LVSba、LVSpm、LVSap、VAC减低,IVST增高（P0.05）；透析低血压组LVEF、CO、SV、LVSba、LVSpm、LVSap、VAC明显低于非低血压组（P0.05）；IVST在透析两组间无统计学差异（P0.05）。LVESV在三组间无统计学差异（P0.05）。 3.相关分析 PWV、β、LVSap与VAC呈正相关（P0.01）。进一步多元线性回归分析，LVSap、β、PWV为VAC独立相关的变量，，标准回归系数分别为0.599、0.113、0.237. 结论 1.维持性血液透析患者血管弹性减低早于血管结构的变化。QIMT及QAS技术检测的血管弹性参数β、PWV是反映动脉弹性功能的敏感指标。 2.维持性血液透析患者左室局部收缩功能减低早于左室整体功能的改变。心肌应变及应变率成像分析（XStrain）技术检测的左室心肌应变是早期反映左室收缩功能改变的敏感指标。 3.维持性血液透析患者心脏血管失耦联，透析低血压者程度加重。左室心尖部心肌应变（LVSap）是评价维持性血液透析患者心脏-血管耦联的敏感指标。血管内中膜分析(QIMT)、血管硬度定量分析（QAS）及心肌应变及应变率成像分析（XStrain）技术可用于对维持性血液透析患者心脏血管耦联关系的评价，为临床早期诊断及治疗提供参考。
[Abstract]:Objective to study the cardio-vascular coupling of maintenance hemodialysis patients using ultrasound radiofrequency signal endovascular media analysis (QIMT), quantitative analysis of vascular hardness (QASs) and myocardial strain and strain rate imaging (strain-rate imaging) technique. Methods 70 patients with maintenance hemodialysis in our hospital were selected. According to the occurrence of hypotension during dialysis, the hemodialysis group was divided into three groups: 33 patients in the hemodialysis group and 37 patients in the non-hypotension group, and 30 healthy persons were selected as the control group. The heart and blood vessels were examined by ultrasound respectively. The common carotid artery intima media thickness (IMT), stiffness coefficient 伪, 尾, pulse wave velocity and PWVV, left ventricular ejection fraction (LVEF), left ventricular septal thickness (LVSET), cardiac output (VT), ventricular output volume (SVN), left ventricular end-systolic volume (LVESVV) were obtained, and cardio-vascular coupling was calculated. The left ventricular basal segment strain (LVSBA), the middle segment strain (LVSpmN), the apical segment strain (LVSapa), the left ventricular basal segment strain (LVSBA), the middle segment strain (LVSpmN) and the apical segment strain were obtained. Results. 1. Vascular ultrasound. Compared with the control group, the blood vessel stiffness parameters PWV, 伪, 尾 in the dialysis group were significantly higher than those in the non-hypotension group (P 0.05), and there was no significant difference between the three groups in the blood vessel stiffness (PWV), 伪 and 尾 (P 0.05). 2. Echocardiography. Compared with the control group, the LVSBA LVSapVAC of LVEF CoSVP / LVSapVAC in dialysis group was lower than that of control group (P 0.05), and that of LVEF CoSVSVLVSban LVSBA LVSapsil VAC in dialysis group was significantly lower than that of non-hypotension group (P0.05IVST). There was no significant difference in LVSapVAC between the three groups (P 0.05N. LVESV). 3. Related analysis. There was a positive correlation between VAC and VAC, and further multivariate linear regression analysis showed that VAC was an independent correlation variable, and the standard regression coefficient was 0.599 / 0.113 / 0.237, respectively. Conclusion. 1. The decrease of vascular elasticity in maintenance hemodialysis patients was earlier than the change of vascular structure. QIMT and QAS were sensitive indexes to reflect the elastic function of artery. 2. The regional systolic function of the left ventricle decreased earlier than that of the whole left ventricular function in the patients with maintenance hemodialysis, and the strain and strain rate imaging technique was used to detect the left ventricular myocardial strain, which was a sensitive index to reflect the change of the left ventricular systolic function in the early stage. 3. Cardiac vascular decoupling in patients with maintenance hemodialysis, Left ventricular apical myocardial strain (LVSapa) is a sensitive index for evaluating cardio-vascular coupling in maintenance hemodialysis patients. VAR analysis can be used to evaluate the cardiac vascular coupling in maintenance hemodialysis patients. To provide reference for early clinical diagnosis and treatment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R459.5

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