实时三维超声心动图对房间隔缺损患者手术前后右房功能的评价
发布时间：2019-03-11 08:39
【摘要】：目的：探讨实时三维超声心动图（RT-3DE）技术评价房间隔缺损（ASD）患者手术前后右房功能的临床价值。 方法：对54例房间隔缺损患者采用RT-3DE监测术前、术后2~3天、1个月、3个月时右心房最大容积（RAVmax）、右心房最小容积（RAVmin）及右心房收缩前容积（RAVpre），右房总射血容量（TASV）、右房被动射血容量（PASV）、右房主动射血容量（AASV）、右房整体射血分数（RAEF）、右房被动射血分数（RAEFpassive）、右房主动射血分数（RAEFactive）。常规超声心动图监测右房横径（RA）、右室内径（RV）、主肺动脉内径（MPA）、肺动脉收缩压、左室舒张末期内径（LVd）、左室收缩末期内径（LVs）、左室每搏输出量（LVSV）、左室射血分数（LVEF）以及30例正常组的上述血流动力学指标。分别比较正常组、ASD术前组与ASD术后各组间的结果。 结果：ASD患者RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV及MPA均高于正常组，RAEF和RAEFpassive指标均低于正常组,差异有统计学意义（P0.05），提示ASD患者术前右房存储功能、泵功能增强，管道功能减低，右房横径、右室内径及主肺动脉内径增宽。ASD患者术后2～3天RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV及MPA均低于术前组，RAEFpassive指标高于术前组，差异有统计学意义（P0.05）；ASD患者术后3个月RAVmax、RAVmin、RAVpre、TASV、RAEFactive、RA、RV、MPA、RAEF和RAEFpassive指标与正常组相比较，差异无统计学意义（P0.05）。ASD术后，右房存储功能、泵功能、管道功能逐渐恢复正常，右房横径、右室及主肺动脉内径缩小，，肺动脉收缩压明显下降，左室内径增大，左室每搏量、左室射血分数增高，心脏重构在随访中持续逆转，其血流动力学明显改善，大多数ASD患者术后三个月右房大小及心室功能基本恢复到正常水平。 结论：ASD手术纠正了心脏解剖畸形和血流动力学异常; RT-3DE能够方便检测ASD手术前后右心血流动力学改变，反映右心功能改变，为临床评价其病变的严重程度、判断预后及掌握ASD术后的恢复情况提供可靠的参考依据。
[Abstract]:Objective: to evaluate the clinical value of real-time three-dimensional echocardiography (RT-3DE) in the evaluation of right atrial function in patients with atrial septal defect (ASD) before and after operation. Methods: 54 patients with atrial septal defect were monitored by RT-3DE before, 2 days, 1 month and 3 months after operation. The maximal right atrium volume (RAVmax), the minimum right atrial volume (RAVmin) and the right atrial presystolic volume (RAVpre),) were used. Right atrial total ejection volume (TASV), right atrial passive ejection volume (PASV), right atrial active ejection volume (AASV), right atrium global ejection fraction (RAEF), right atrial passive ejection fraction (RAEFpassive), right atrial active ejection fraction (RAEFactive). Routine echocardiography monitoring right atrial diameter (RA), right ventricular diameter (RV), pulmonary artery diameter (MPA), pulmonary artery systolic pressure left ventricular end diastolic diameter (LVd), left ventricular end systolic diameter (LVs), left ventricular stroke volume (LVSV), Left ventricular ejection fraction (LVEF) and hemodynamic parameters were measured in 30 normal subjects. The results of normal group, pre-ASD group and post-ASD group were compared. Results: the levels of RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA in patients with ASD were higher than those in normal group, while the indexes of RAEF and RAEFpassive in patients with ASD were lower than those in normal group (P0.05), suggesting that the function of right atrium storage and pump in patients with ASD were enhanced before operation. The diameter of right atrium, right ventricle and main pulmonary artery were widened in patients with ASD. RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA were lower than those in preoperative group at 2 days and 3 days after operation, and RAEFpassive indexes were higher than those in preoperative group. The difference was statistically significant (P0.05); There was no significant difference in RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV,MPA,RAEF and RAEFpassive between ASD patients and normal group 3 months after operation (P0.05). Right atrial storage function, pump function and pipeline function gradually returned to normal after operation. The diameter of right atrium, the diameter of right ventricle and main pulmonary artery decreased, the systolic pressure of pulmonary artery decreased significantly, the inner diameter of left ventricle increased, left ventricular stroke volume and left ventricular ejection fraction increased, cardiac remodeling continued to reverse during follow-up, and its hemodynamics was improved obviously. The size of right atrium and ventricular function returned to normal level in most patients with ASD three months after operation. Conclusion: ASD operation can correct cardiac anatomical malformation and hemodynamic abnormality. RT-3DE can conveniently detect the hemodynamic changes of the right heart before and after ASD operation, reflect the changes of the right heart function, and provide reliable reference for evaluating the severity of the lesion, judging the prognosis and mastering the recovery of the patients after ASD.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R540.45
本文编号：2438135
[Abstract]:Objective: to evaluate the clinical value of real-time three-dimensional echocardiography (RT-3DE) in the evaluation of right atrial function in patients with atrial septal defect (ASD) before and after operation. Methods: 54 patients with atrial septal defect were monitored by RT-3DE before, 2 days, 1 month and 3 months after operation. The maximal right atrium volume (RAVmax), the minimum right atrial volume (RAVmin) and the right atrial presystolic volume (RAVpre),) were used. Right atrial total ejection volume (TASV), right atrial passive ejection volume (PASV), right atrial active ejection volume (AASV), right atrium global ejection fraction (RAEF), right atrial passive ejection fraction (RAEFpassive), right atrial active ejection fraction (RAEFactive). Routine echocardiography monitoring right atrial diameter (RA), right ventricular diameter (RV), pulmonary artery diameter (MPA), pulmonary artery systolic pressure left ventricular end diastolic diameter (LVd), left ventricular end systolic diameter (LVs), left ventricular stroke volume (LVSV), Left ventricular ejection fraction (LVEF) and hemodynamic parameters were measured in 30 normal subjects. The results of normal group, pre-ASD group and post-ASD group were compared. Results: the levels of RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA in patients with ASD were higher than those in normal group, while the indexes of RAEF and RAEFpassive in patients with ASD were lower than those in normal group (P0.05), suggesting that the function of right atrium storage and pump in patients with ASD were enhanced before operation. The diameter of right atrium, right ventricle and main pulmonary artery were widened in patients with ASD. RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV and MPA were lower than those in preoperative group at 2 days and 3 days after operation, and RAEFpassive indexes were higher than those in preoperative group. The difference was statistically significant (P0.05); There was no significant difference in RAVmax,RAVmin,RAVpre,TASV,RAEFactive,RA,RV,MPA,RAEF and RAEFpassive between ASD patients and normal group 3 months after operation (P0.05). Right atrial storage function, pump function and pipeline function gradually returned to normal after operation. The diameter of right atrium, the diameter of right ventricle and main pulmonary artery decreased, the systolic pressure of pulmonary artery decreased significantly, the inner diameter of left ventricle increased, left ventricular stroke volume and left ventricular ejection fraction increased, cardiac remodeling continued to reverse during follow-up, and its hemodynamics was improved obviously. The size of right atrium and ventricular function returned to normal level in most patients with ASD three months after operation. Conclusion: ASD operation can correct cardiac anatomical malformation and hemodynamic abnormality. RT-3DE can conveniently detect the hemodynamic changes of the right heart before and after ASD operation, reflect the changes of the right heart function, and provide reliable reference for evaluating the severity of the lesion, judging the prognosis and mastering the recovery of the patients after ASD.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R540.45
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