超声三维斑点追踪技术对冠心病患者PCI前后左室壁运动的评价与分析

发布时间：2018-03-14 05:16

本文选题：三维斑点追踪　切入点：应变　出处：《蚌埠医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：应用三维斑点追踪显像技术（3D-STI）联合常规超声心动图观察冠状动脉粥样硬化性心脏病，简称冠心病（CAD）。经皮冠状动脉介入(PCI)治疗前后左室节段及整体收缩功能的变化，分析PCI治疗对冠心病再灌注治疗的短期疗效，探讨PCI对冠状动脉粥样硬化性心脏病左室节段及整体收缩功能影响的三维斑点追踪显像技术评价。方法：分别对30例左心室射血分数(LVEF)50%的冠状动脉粥样硬化性心脏病患者进行PCI治疗，在患者接受治疗前、治疗后7天内以及治疗后3个月时及30例正常对照组进行三维斑点追踪显像技术分析，测量出舒张末期左心室容血量（LVEDV）、收缩末期左心室容血量（LVESV）、左心室每搏输出量占心室舒张末期容积量的百分比，即射血分数(LVEF)及左室壁上的各个心肌节段在径向、纵向、圆周三方面的应变峰值(LSpeak、RSpeak、CSpeak)和达到峰值所需要的时间(TPSRS、TPSLS、TPSCS)。结果：与对照组比较，冠心病患者组PCI治疗前后LVESV、LVEDV较对照组扩大，LVEF比对照组降低，变化均有明显统计学意义(P均0.05)。与PCI治疗前比较，PCI后7天LVESV、LVEDV及LVEF都没有明显改变，变化无统计学意义(P均0.05)。PCI治疗后3个月时LVESV、LVEDV比PCI治疗前及PCI治疗后7天内都有一定的缩小，LVEF增高，变化均有统计学意义(P均0.05)。与对照组相比，冠心病患者组PCI治疗前后各梗死心肌节段最大收缩期RSpeak、LSpeak、CSpeak比对照组降低，应变峰值达峰时间TPSRS、TPSLS、TPSCS较对照组增加，变化有统计学意义(P均0.05)。与PCI治疗前比较，，PCI治疗后7天内各梗死心肌节段最大收缩期RSpeak、LSpeak、CSpeak有一定增高，应变峰值达峰时间TPSRS、TPSLS、TPSCS有一定减少，变化有统计学意义(P均0.05)；PCI治疗后3个月后各梗死心肌节段最大收缩期RSpeak、LSpeak、CSpeak明显增高，应变峰值达峰时间TPSRS、TPSLS、TPSCS明显减少，变化有统计学意义(P均0.05)。结论： 1、冠心病患者由于冠状动脉阻塞引起相应节段心肌的应变明显减低，左心室的一部分或者整体的收缩功能下降。 2、经皮冠状动脉介入术治疗后，血液会重新灌注缺血心肌，左心室收缩功能会随着时间的推移恢复得越来越好。 3、3D-STI的优点是能够对左心室每个区域的三维应变值进行快速的、准确及定量的捕捉，并且能够对异常的左心室室壁运动进行准确的评估，从而对临床中冠心病患者在左心室局部收缩功能异常的评价中提供无创、定量的方法。
[Abstract]:Objective:. Three-dimensional speckle tracing imaging (3D-STI) combined with conventional echocardiography was used to observe the changes of left ventricular segment and global systolic function before and after percutaneous coronary intervention (PCI) treatment for coronary atherosclerotic heart disease (CAD). To evaluate the effects of PCI on left ventricular segment and global systolic function in patients with coronary artery disease (CAD) and to evaluate the effects of PCI on left ventricular segment and global systolic function in patients with coronary artery disease (CHD). Methods:. 30 patients with left ventricular ejection fraction (LVEF) 50% of coronary atherosclerotic heart disease were treated with PCI. Three dimensional speckle tracing imaging was performed within 7 days after treatment, 3 months after treatment and 30 normal controls. Left ventricular volume (LVV), left ventricular volume (LVV), left ventricular volume (LVV) at the end of diastolic period (LVV), left ventricular volume (LVV) at the end of systolic period (LVV), left ventricular output (LVO) as a percentage of LVV (ejection fraction) and myocardial segments on the wall of the left ventricle (LVEF) were measured in radial and longitudinal directions. The strain peak in three aspects of the circle is LSpeak-RSpeak-CSpeak) and the time needed to reach the peak value is TPSRS / TPSLS / TPSCS. Results:. Compared with the control group, the LVESVV / LVEDV in the CHD group was lower than that in the control group before and after PCI treatment, and the changes were statistically significant (P < 0.05). There were no significant changes in LVESVV, LVEDV and LVEF 7 days after PCI treatment in patients with coronary heart disease. There was no significant difference in the changes of LVEVDV between before and after PCI treatment and within 7 days after PCI treatment (P < 0.05, P < 0.05). Compared with the control group, the changes of LVEDV were significantly higher than those before PCI treatment and within 7 days after PCI treatment, and the changes were significantly higher than those in the control group (P < 0.05). Before and after PCI treatment, the maximal systolic phase of myocardial infarction in coronary heart disease group was lower than that in the control group, and the peak strain peak time (TPSRS) was higher than that in the control group. The changes were statistically significant (P < 0.05), compared with those before PCI treatment, the maximal systolic peak of myocardial segments in each infarct was increased in 7 days after PCI, and the peak strain peak time (TPSRS) was decreased, and the peak strain peak time (TPSSRS) was decreased. The changes were statistically significant (P < 0.05). After 3 months of PCI, the maximal systolic peak value of RSpeaker-LSpeak-LSpeak-CSpeak was significantly increased, and the peak strain peak time (TPSRS) of TPSLSS-TPSLSSCS was significantly decreased (P < 0.05). Conclusion:. 1. In patients with coronary heart disease, the strain of the corresponding segment of myocardium was significantly decreased and the systolic function of the left ventricular part or whole was decreased due to coronary artery occlusion. 2. After percutaneous coronary intervention, the blood reperfuses the ischemic myocardium, and the left ventricular systolic function recovers over time. 3D-STI has the advantage of fast, accurate and quantitative capture of the three dimensional strain values in each region of the left ventricle, and an accurate assessment of the abnormal left ventricular wall motion. Therefore, it provides a noninvasive and quantitative method for the evaluation of left ventricular regional systolic dysfunction in patients with coronary heart disease.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.4

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