二维斑点追踪技术评价房间隔缺损患者封堵术前、后左室收缩功能的变化

发布时间：2018-07-17 05:53

【摘要】：【目的】房间隔缺损(atrial septal defect,ASD)是常见的先天性心脏病之一,持续的房水平左向右分流可导致右心室、右心房容量负荷增加,进而导致右心扩大以及肺动脉高压。右室增大导致室间隔与左室后壁同向运动,扩大的右室压迫左室,引起左心功能不同程度减低。严重者可导致心力衰竭,甚至死亡。近年来,随着微创医学的发展,经皮导管介入封堵术以其创面小、术后康复快、住院周期短以及并发症少等优势被临床认为是首选治疗。二维斑点追踪技术成像(Speckle Tracking Imaging,STI)从纵向、环向、径向多个方面对心肌力学特征进行多方位的评价,可以定量评价心肌运动速度、应变、应变率等,另外可获得心室的扭转运动参数,从而评价左室整体和区域心肌收缩功能。本实验主要是应用STI技术获得房间隔缺损患者封堵术前后左心室收缩期圆周应变与径向应变以及左心室旋转、扭转的相关参数的变化,来探讨房间隔缺损患者封堵手术前、后左室收缩功能的变化。为评价ASD封堵术前、后左心室收缩功能的评价提供新的方法。【方法】选取继发孔房间隔缺损(asd组)患者30例作为病例组;同期选择我院性别、年龄相匹配的健康正常人30例作为对照组(nc组)。分别于术前、术后2天、术后6月常规测量右房舒张末内径(rightatrialend-diastolicdiameter,rvdd)、右室舒张末内径(rightventricularend-diastolicdiameter,radd),左室舒张末内径(leftventricularend-diastolicdiameter,lvdd),左室舒张末容积(leftventricularend-diastolicvolume,lvedv)及左室收缩末容积(leftventricularend-systolicvolume,lvesv),并通过双平面改良simpson法获得左心室射血分数(leftventricularejectionfraction,lvef)及左室每搏输出量(leftventricularstrokevolume,lvsv)。留取左心室短轴三个水平(基底水平、中部及心尖水平)的动态二维超声图像,导入echopac工作站获取左心室应变参数以及扭转参数。第一部分:斑点追踪技术对房间隔缺损封堵术前、后左室短轴应变的定量评价通过sti分析后系统自动得出左心室各平面各节段的径向应变(radialstrain,sr)-时间曲线及圆周应变(circumferentialstrain,sc)-时间曲线。软件自动将左心室短轴分为六个节段:前间隔、前壁、侧壁、下壁、后壁及中后间隔。获取左室短轴各节段的圆周及径向应变峰值及达峰时间,将各节段应变峰值总和后取平均值作为整体应变峰值。将得到的数据进行统计分析。第二部分:二维斑点追踪技术对房间隔缺损封堵术前、后左心室扭转运动的定量评价同样经过sti分析后得到基底旋转角度-时间曲线、心尖旋转角度-时间曲线及左室扭转-时间曲线,分别测量旋转角度峰值、扭转角度的峰值及其对应的达峰时间,然后将进行统计学分析。【结果】(1)常规参数比较:病例组rv及ra术前舒张末内径大于对照组(p0.05),术后2天较术前组减小(p0.05)并接近对照组。病例组术前lv前后径、lv左右径小于对照组(p0.05),术后2天增加(p0.05)并接近于对照组。病例组术前lvedv、lvsv组均小于对照组(p0.05),术后2天较术前增大(p0.05),术后6个月进一步增大(p0.05)并接近于对照组。病例组lvesv、lvef术前小于对照组(p0.05),术后2天即较术前增大(p0.05)并接近于对照组。(2)左室各节段圆周应变比较:病例组封堵术前各节段的圆周应变峰值均低于对照组(p0.05)。前间隔、前壁、侧壁、后壁术后2天较术前显著增高(p0.05),亦高于对照组(p0.05),术后6个月减低(p0.05)接近于对照组。病例组下壁、中后间隔术后2天即增高(p0.05)并接近于对照组。(3)左室各节段径向应变比较:病例组除后壁外余左室各节段的径向应变峰值均低于对照组(p0.05),术后2天增高(p0.05)并接近于对照组;后壁径向应变术前高于对照组(p0.05),术后2天无明显变化,术后6个月减低(p㩳0.05),接近于对照组。(4)左心室整体应变的比较:病例组左室整体圆周应变术前低于对照组(p㩳0.05);封堵术后2天增高(p㩳0.05),亦高于对照组(p㩳0.05);术后6个月又降低(p㩳0.05)并接近于对照组。病例组左室整体径向应变术前与对照组无统计学差异,封堵术后2天增高(p㩳0.05),亦高于对照组(p㩳0.05),术后6个月降低(p㩳0.05)至正常。(5)左室基底水平各节段旋转角度峰值比较:与对照组比较,病例组术前左室基底水平除后壁外余各节段旋转角度峰值显著减低(p㩳0.05)。术后2天病例组左室基底水平前壁、侧壁旋转角度峰值较术前显著增高(p㩳0.05)并接近于对照组;前间隔、下壁及中后间隔术后2天无显著变化,至术后6个月增高(p㩳0.05)并接近正常水平。病例组左室基底水平后壁旋转角度峰值术前较对照组显著增高(p㩳0.05),术后2天即减低(p㩳0.05)并接近对照组。(6)左室心尖水平各节段旋转角度峰值比较:病例组术前左室心尖水平各节段的旋转角度峰值均高于对照组(p㩳0.05),术后2天无明显变化,术后6个月减低(p㩳0.05)并接近于对照组。(7)左室整体最大扭转角度的比较:病例组左室整体最大扭转角度术前小于对照组,术后2天即较术前增高(p㩳0.05)并接近于对照组。(8)左室应变达峰时间、旋转达峰时间及扭转达峰时间在病例组与对照组之间无统计学差异,且这些参数在病例组封堵术前、后亦无统计学差异。【结论】(1)本研究证实应用二维斑点追踪技术可以评价经皮导管介入封堵术前、后左室各节段及整体圆周应变、径向应变的变化,左室各节段旋转角度及整体扭转角度的变化。(2)右心容量负荷增加可引起左室收缩功能不同程度减低。(3)经皮导管介入封堵术阻断了房水平左向右分流,使得右心容量负荷减低,室间隔及左室后壁运动恢复正常,左室前负荷增加,扩张性增加,左室形态发生几何重构和逆转重构,左室的容积和收缩功能得到改善。(4)封堵术后左室即刻进行几何重构,持续逆转重构,直至术后六个月趋向于稳定。
[Abstract]:Left ventricular septal defect ( ASD ) is one of the most common congenital heart diseases . Left - to - right shunt in the right ventricle leads to the enlargement of right ventricle and right atrium volume , which leads to the enlargement of right ventricle and pulmonary hypertension . 30 patients with atrial septal defect ( asd group ) were selected as control group ( n = 30 ) . The right atrial end - diastolicdiameter ( rvdd ) , right ventricular end - diastolic diameter ( rvdd ) , left ventricular end - diastolic volume ( lvef ) and left ventricular systolic volume ( lvesv ) were measured by double - plane modified simpson method , and left ventricular ejection fraction ( lvef ) and left ventricular stroke volume ( lvsv ) were measured . A quantitative evaluation of left ventricular short axis strain before and after transcatheter closure of atrial septal defect ( P 0.05 ) was performed on the left ventricular short axis . ( 3 ) Compared with the control group , the peak value of left ventricular basal level in the left ventricle was significantly higher than that in the control group ( p ? 0.05 ) . The peak value of the left ventricular basal level was lower than that in the control group ( p ? 0.05 ) . Conclusion : ( 1 ) This study demonstrated that the two - dimensional speckle tracking technique can evaluate the changes of left ventricular contraction function before and after percutaneous catheter interventional occlusion . ( 2 ) Increased right ventricular volume load can cause different degrees of left ventricular systolic function . ( 3 ) The right ventricular volume load is decreased , ventricular septal and posterior wall motion of left ventricle are normal , the volume and contraction function of left ventricle are improved . ( 4 ) After occlusion , the left ventricle is geometrically reconstructed and reconstructed continuously , and the left ventricle tends to be stable for six months .
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R541.1

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