二维超声心动图采用内缘—内缘方法测量健康成人主动脉根部直径

发布时间：2018-03-12 06:46

本文选题：超声心动描记术　切入点：主动脉根部　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:测量主动脉直径对诊断和监测主动脉疾病具有重要意义,但至目前关于主动脉直径的测量尚没有统一的标准。本文旨在应用二维超声心动图采用内缘-内缘方法研究健康成人主动脉根部(Aorta root,AoR)直径参考值及其随年龄、性别及体表面积(body surface area,BSA)改变的变化规律。方法:选取太钢总医院体检中心和门诊健康成人306例,既往无心血管病、高血压、糖尿病、瓣膜及先天性心脏病、主动脉二瓣化、心力衰竭、心肌病、窦性心动过速、内分泌系统疾病、妊娠及使用违禁药物史,经实验室、心电图、X线胸片及常规超声心动图检查无异常;BMI28kg/m2;5例因图像质量差不能清晰显示主动脉长轴而被剔除(胸廓畸形和肋间隙狭窄等原因造成),余301例(年龄45.8±15.8岁,男146例,女155例)纳入本研究,依性别分两组,按年龄分五组,并通过太钢总医院伦理委员会的批准,同时得到所有受试者的知情同意。采用美国GE的VividE9彩色多普勒超声诊断仪,配置M5S-D二维探头(频率1.5-4.5MHz)对所有研究对象行标准二维超声心动图检查,于胸骨旁主动脉长轴采用内缘-内缘的方法测量AoR直径,除瓣环(aortic annulus,AoA)于收缩中期测量外,窦部(the sinuses of Valsalva,AoS)、窦管连接部(the sinotubular junction,AoST)及升主动脉近端(the proximal ascending aorta,AAo)于舒张末期测量,确保测量线垂直于主动脉长轴。数据采集由两位具有五年以上工作经历的医师完成,测量数据由其中一位医师完成。同步记录心电图,连续采集五个心动周期,并采用心电图确定测量时间点。M型超声于左室长轴水平测量舒张期和收缩期左室内径、室间隔和左室后壁厚度。采用多普勒血流显像评估心脏四个瓣膜的有无返流及返流程度,采集标准的心尖四腔、两腔、三腔切面,储存于机内。采用非配对t检验分析不同性别间的差异;多元回归分析年龄、性别、体表面积、身高及体重对主动脉直径的影响;随机抽取30例研究对象,采用Person相关和Bland-Altman法进行重复性检验,分析观察者内及观察者之间测量的一致性;以p0.05认为有统计学意义。结果:AoA、AoS、AoST及AAo近端的95%上界值各为男性:20.93mm,33.02mm,28.50mm和30.67mm;女性:19.12mm,30.72mm,27.72mm和30.50mm。随年龄增长,除AoA外,AoS、AoST及AAo近端直径均有增大趋势,男性大于女性(P0.01)。BSA标化后,AoA与年龄无相关性;AoS、AoST及AAo近端与年龄有相关性(r=0.254、0.411和0.511,均P0.001);标化后男性AoST及AAo近端小于女性(P=0.01、0.001),而AoA和AoS性别间无差异。多元回归分析AoR与年龄、性别及BSA有相关性,R2为0.19-0.33,AoA与年龄无显著相关(β=-0.007,P=0.89),身高、体重对AoR直径无额外影响。Person相关和Blant-Altman法分析观察者内和观察者间的差异:观察者内AoA r=0.84,AoS r=0.85,AoST r=0.84,AAo r=0.87,一致性检验:AoA 0.5±2.35mm,AoS 0.5±2.35mm,AoST 0.6±3.35mm,AAo 0.1±2.8mm;观察者间AoA r=0.87,AoS r=0.79,AoST r=0.81,AAo r=0.77,一致性检验:AoA 1.2±2.1mm,AoS 0.6±2.1mm,AoST 0.6±3.7mm,AAo 1.0±4.8mm。结论:初步建立了健康成人内缘-内缘方法学测量AoR直径的正常参考值范围,探讨了主动脉AoS、AoST及AAo近端直径随年龄增长有增大趋势的变化规律,这可能为主动脉结构和血流动力学研究以及对AoR疾病的临床诊断、疗效评价和预后判断提供了重要参考依据。
[Abstract]:Objective: to measure the diameter of the aorta is of great significance to the diagnosis and monitoring of aortic disease, but to the measurement of the aortic diameter there is no unified standards. This paper aimed at the application of two-dimensional echocardiography on aortic root using healthy adult inner - Inner method (Aorta root AoR) and the diameter of the reference value with age, sex and body surface area (body surface area, BSA) changing rules. Methods: healthy adult Taigang general hospital medical center and clinic in 306 cases, no previous history of cardiovascular disease, hypertension, diabetes mellitus, valvular and congenital heart disease, aortic valve two, cardiomyopathy, heart failure, sinus tachycardia, endocrine system diseases, pregnancy and use drug history, laboratory, electrocardiogram, chest X-ray and echocardiography examination no abnormalities; BMI28kg/m2; 5 cases due to poor image quality can clearly display the aortic long axis Was rejected (caused by thoracic deformity and narrow intercostal space and other reasons), more than 301 cases (age 45.8 + 15.8 years old, male 146 cases, female 155 cases) were included in this study, according to sex were divided into two groups, divided into five groups according to age, and by Taigang General Hospital ethics committee approval, and informed consent all of the subjects. Using the GE VividE9 color Doppler ultrasonic diagnostic apparatus, configuration of two-dimensional M5S-D probe (frequency 1.5-4.5MHz) all subjects underwent standard two-dimensional echocardiography in the parasternal long axis of aorta by means of Inner - inner diameter measurement AoR, except the valve ring (aortic annulus, AoA) on the contraction interim survey, antrum (the sinuses of Valsalva, AoS), sinus pipe junction (the sinotubular, junction, AoST) and the proximal ascending aorta (the proximal ascending aorta, AAo) in diastolic measurements, ensure the measuring line perpendicular to the long axis of aorta by data acquisition. Two more than five years working experience of the surgeon, the measurement data by one surgeon. ECG, continuous acquisition of five cardiac cycles, and determine the measurement time point.M ultrasonic level measurement in left ventricular diastolic and systolic left ventricular diameter by ECG, ventricular septum and left ventricular posterior wall thickness. Using the Doppler flow imaging assessment of cardiac valve four has no reflux and reflux, collecting standard apical four chamber, two chamber, three chamber view, stored in the machine. Using non paired t test analysis of differences between genders; multiple regression analysis, age, gender, height and body surface area, influence the weight of aortic diameter; 30 patients were randomly selected for the research object, repetition test by using Person and Bland-Altman method, the consistency between the observer and the observer analysis; P0.05 was considered statistically significant Results: AoA, AoS, AoST and AAo 95% upper bound of the proximal end of the value of each male: 20.93mm, 33.02mm, 28.50mm and 30.67mm; 19.12mm, 30.72mm, 27.72mm: women and 30.50mm. with age, except AoA, AoS, AoST and AAo proximal diameter were increasing trend, male more than female (P0.01.BSA) after standardization, there is no correlation between AoA and AoS, AoST and AAo age; the proximal end was correlated with age (r=0.254,0.411 and 0.511, P0.001); standardized male AoST and proximal AAo lower than that of the female (P=0.01,0.001), while AoA and AoS had no difference between gender. Multiple AoR regression analysis with age, gender relationship and BSA, R2 for 0.19-0.33, no significant correlation of AoA with age (beta =-0.007, P=0.89), height, weight and no additional influence on the AoR diameter of the intra observer and.Person correlation and Blant-Altman method between the intra observer differences: AoA r=0.84, AoS R =0.85, AoST r=0.84, AAo r=0.87, consistency test AoA: 0.5 + 2. 35mm, AoS AoST 0.5 + 2.35mm, 0.6 + 3.35mm, 0.1 + AAo 2.8mm; inter observer AoA r=0.87, AoS r=0.79, AoST r=0.81, AAo r=0.77, consistency test: AoA 1.2 + 2.1mm AoS 0.6 + 2.1mm, 0.6 + AoST 3.7mm AAo + 4.8mm., 1 conclusions: the initial establishment of a healthy adult inner - the normal reference measurement method of inner diameter AoR value range of AoS, AoST and AAo in aorta and proximal diameter changes with age increasing, the possibility to research the structure and hemodynamics of aorta and the clinical diagnosis of AoR disease, and provides an important reference for the efficacy evaluation and prognosis.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45

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