左室收缩功能减退者右室收缩功能的超声心动图研究

发布时间：2018-04-18 22:41

  本文选题：心室功能 + 右　； 参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：研究背景和目的:左心衰竭是左心室收缩和/或舒张功能严重受损的表现和结果,其诊断和治疗始终是临床的关注热点和难点。研究证实左心衰竭患者一旦出现右心功能不全,死亡率和再住院率明显增高,因此右心功能不全的发生与否及程度对临床决策和用药有重要参考价值。然而目前关于左心衰竭患者右心功能的研究较少,本研究拟对左室收缩功能减退患者的右室收缩功能进行评估,重点探讨左室收缩功能减退发生右室收缩功能减退的可能影响因素。材料与方法:对128例疑诊左心衰竭患者行超声心动图检查,测量左室射血分数(LVEF),据入组标准(LVEF50%)最终110例患者(男78例,女32例)诊断为左室收缩功能减退并纳入左心衰组,所有患者观测二尖瓣舒张早、晚期峰值速度(E、A)和组织多普勒二尖瓣环舒张早期峰值速度(e')并计算E/A、E/e',三尖瓣反流压差并估测肺动脉收缩压(PASP)、肺动脉血流加速时间(AT)、左室侧壁达峰时间(LVW TTP)、右室侧壁达峰时间(RVW TTP)并计算差值(LVW-RVW TTP),以及主、肺动脉射血前间期(APEI、PEPT)然后得出二者差值(IVD)。进一步根据左室收缩功能减低程度、是否伴有肺高压、是否合并舒张功能减退及是否合并心室间收缩运动失同步将左心衰患者进一步划分为:轻-中度(35%LVEF50%)和重度(LVEF≤35%),伴肺高压(PASP≥35mmHg)和不伴肺高压(PASP35mmHg),合并舒张功能减退(E/e' 14、e' 7)和不合并舒张功能减退(E/e'≤14及e'≥7)以及心室间收缩运动同步(LVW-RVWTTP≤40ms或IVD≤40ms)和心室间收缩运动失同步(LVW-RVW TTP40ms或IVD40ms)等不同亚组。同期选取性别、年龄匹配的65名门诊查体健康者(LVEF55%)为对照组。超声心动图检查所有受试者的右心室收缩功能参数:三尖瓣环收缩期位移(TAPSE)、右心室面积变化率(RVFAC)、三尖瓣环收缩期峰值速度(S')。比较上述左心衰各亚组与对照组的右心室收缩功能;并分析各亚组主要诊断参数与右心室收缩功能参数的相关性,回归分析采用曲线拟合法,分析影响因素与右室收缩功能的关系模型及影响程度。结果:左心衰组39% (43/110)发生右室收缩功能不全。各亚组间比较显示:轻-中度与重度左心衰组的右室收缩功能较对照组均有不同程度减低,且重度左心衰组右室收缩功能减低程度较轻-中度左心衰组加重:TAPSE (16. 9±2. 5 VS18. 5±3.3)mm、RVFAC(38. 1±7. 6VS 45. 1±8.4)%、S' (8. 9±2.3 VS 11.3±3. 5)cm/s(P均0. 05);左心衰伴肺高压组的右室收缩功能减低程度较不伴肺高压组减低程度增加:TAPSE(15. 9±1.9 VS 17. 9±2. 9)mm、 RVFAC (35. 9±4. 4 VS42. 3±7. 9)%(P0. 05);左心衰合并舒张功能减退组的右室收缩功能减低程度较不合并舒张功能减退组加重:TAPSE (16. 9 ± 2. 5VS17. 8 ± 3. 1) mm、RVFAC (38. 1 ± 6. 7VS43. 8 ±7. 7)% (P均0.05);左心衰合并左、右心室间收缩运动失同步与心室间收缩运动同步组比较,右室收缩功能的差异无统计学意义(P0. 05)。各亚组主要诊断参数与右室收缩功能参数的相关分析:LVEF与TAPSE、RVFAC、S'呈轻度正相关(r=0. 327, 0. 405,0.365,P0. 05),PASP 与 TAPSE、RVFAC、S'轻到中度负相关(r=-0.468, -0.519, -0.443, P0. 01); E/e'与 RVFAC、S'呈轻度负相关(r=-0. 326, -0. 292, P0. 05) ; LVW-RVW TTP、IVD 与 TAPSE、FAC、S'均无明显相关(r=-0.080/-0. 078,-0.028/0.169, -0.073/-0. 015,P0. 05)。回归分析显示:LVEF与TAPSE、RVFAC、S'复合模型拟合最优(R2=0. 107、0.164、0.133,P0. 01),方程:y(RVFAC)则=26. 932+1. 11x: PASP 与 TAPSE、RVFAC、S'三次模型拟合最优(R2=0. 219、0.269、0.196,P0. 05),方程:y(RVFAC)=32. 226+1. 178x-0. 037x2; E/e'与 RVFAC、S'二次模型拟合最优(R2=0. 106、0. 085, P0. 05),方程:y(RVFAC)=48. 076-0. 564x+0. 006x2,以上拟合模型均显著,提示左室收缩功能减退患者的右室收缩功能减低一定程度上由LVEF、PASP及E/e'的变化所致,影响程度分别为16.4%、26. 9%、10. 6%。结论:左室收缩功能减退患者存在不同程度的右室收缩功能减退,右室收缩功能减退的发生和程度与左室收缩功能减退程度、是否合并左心疾病相关性肺高压和左室舒张功能减退有关。
[Abstract]:Background and objective: left heart failure is the performance and results of left ventricular diastolic function and / or severely damaged, the diagnosis and treatment of concern has always been hot and difficult. The clinical study confirmed that patients with left heart failure once right heart dysfunction, mortality and readmission rate was significantly higher, so the function of right heart the incidence of incomplete or not and the degree has important reference value for clinical decision-making and medication. However, on the left heart failure patients with right heart function research, this study on left ventricular systolic function of right ventricular systolic function in patients were assessed, focusing on left ventricular systolic function of right ventricular systolic dysfunction may occur the influence of factors. Materials and methods: 128 patients with suspected heart failure patients with echocardiography, measurement of left ventricular ejection fraction (LVEF), according to the inclusion criteria (LVEF50%) 110 patients (male 78 cases, female 32 cases) Diagnosis of left ventricular systolic function of left heart failure group and included all patients, observation of mitral diastolic early, late peak velocity (E, A) and Doppler tissue mitral annular early diastolic peak velocity (E') and calculate the E/A, E/e', three tricuspid regurgitation pressure and estimation of pulmonary artery systolic pressure (PASP), lung arterial blood flow acceleration time (AT), left ventricular lateral wall peak time (LVW TTP), right ventricular lateral wall peak time (RVW TTP) and calculate the difference (LVW-RVW TTP), and the main pulmonary artery, pre ejection intervals (APEI, PEPT) and the difference between the two (IVD). According to the left ventricular systolic dysfunction, whether with pulmonary hypertension, with diastolic dysfunction and with inter ventricular systolic dyssynchrony in patients with left heart failure will be further divided into: mild to moderate (35%LVEF50%) and severe (LVEF = 35%), patients with pulmonary hypertension (PASP = 35mmHg) and without pulmonary hypertension (PASP35mmHg) and with diastolic function Decreased (E/e'14, E' 7) and not with diastolic dysfunction (E/e'= 14 and E' = 7) and inter ventricular contraction synchronization (LVW-RVWTTP = 40ms or IVD = 40ms) and inter ventricular systolic dyssynchrony (LVW-RVW TTP40ms or IVD40ms) of different sub groups. Selected 65 outpatients in sex. The age-matched healthy persons (LVEF55%) as the control group. Right ventricular systolic function parameters of echocardiography in all subjects: three tricuspid annular systolic displacement (TAPSE), right ventricular fractional area change (RVFAC), three tricuspid annular peak systolic velocity (S'). The comparison of the left heart failure sub group and control group, the right ventricular systolic function; correlation and analysis of the main parameters and diagnostic subgroups of right ventricular systolic function parameters, regression analysis by curve fitting method, analysis of the relationship between the model and the influence factors and the right ventricular systolic function. Results: left heart failure group 39% (43/110). 鐢熷彸瀹ゆ敹缂╁姛鑳戒笉鍏，

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