超声二维斑点追踪技术评价APTE患者右室局部收缩功能

发布时间：2018-04-05 15:27

本文选题：超声心动描记术　切入点：斑点追踪技术　出处：《山西医科大学》2012年硕士论文

【摘要】：目的：观察急性肺栓塞（APTE）患者抗凝、溶栓治疗前后右室心肌应变、应变达峰时间的特点，探讨二维斑点追踪（2D-STI）技术在APTE患者疗效评价的价值。观察不同程度APTE患者右室侧壁心肌应变的特点，探讨2D-STI技术定量分析不同程度APTE患者右室局部收缩功能改变的价值。方法：临床及CT肺动脉造影（CTPA）确诊的急性肺栓塞患者34例，其中25例于治疗后（17.64±7.93）天再次行超声检查；根据临床标准将其分为大面积APTE（15例）、次大面积APTE（10例）、非大面积APTE（9例）三组。正常对照组30例。应用STI技术测量并记录右室侧壁及室间隔的基底段、中间段、心尖段内膜（ENDO）及外膜（EPI）下的心肌纵向收缩峰值应变（PSS）和应变达峰时间（ST），并计算达峰时间均数（STM）和标准差（STSD）。结果：①心内外膜下，APTE患者治疗前右室侧壁及室间隔各节段PSS均低于对照组，差异有统计学意义（P0.05）。②心内膜下，APTE患者治疗后右室侧壁及室间隔各节段PSS均高于治疗前，差异有统计学意义（P0.05）；治疗后右室侧壁及室间隔心尖段PSS与对照组比较差异无统计学意义（P0.05），其他各节段PSS低于对照组，，差异有统计学意义（P0.05）。③心外膜下，APTE患者治疗后右室侧壁及室间隔各节段PSS均高于治疗前，低于对照组，差异有统计学意义（P0.05）。④APTE治疗前后ENDO-STSD、EPI-STSD高于对照组，APTE治疗后ENDO-STSD、EPI-STSD低于治疗前，差异有统计学意义（P0.05）。 ①大面积、次大面积APTE患者右室侧壁内、外膜下心肌各节段PSS低于对照组（P0.05），非大面积APTE患者右室侧壁内膜下中间段及外膜下各节段PSS低于对照组（P0.05）。②非大面积、次大面积、大面积APTE患者右室侧壁各节段心肌PSS依次减低。大面积与次大面积APTE患者间右室侧壁内、外膜下各节段心肌PSS差异均无统计学意义（P0.05）；大面积APTE患者内外膜下基底段、中间段及内膜下心尖段心肌PSS低于非大面积组（P0.05）；次大面积APTE患者内外膜下基底段及内膜下心尖段心肌PSS低于非大面积组（P0.05）。结论：1.APTE患者右室心肌各节段PSS减低，心肌应变达峰时间标准差增大；APTE治疗后有所恢复，但心肌应变仍减低，应变达峰时间标准差仍高于对照组。二维斑点追踪技术可客观评价APTE患者治疗后疗效。2.大面积、次大面积APTE患者右室侧壁心肌应变显著降低，非大面积APTE患者右室侧壁部分节段心肌应变降低，2D-STI技术可定量评价APTE患者不同程度栓塞时右室局部收缩功能。
[Abstract]:Objective: to observe the characteristics of anticoagulant and thrombolytic therapy in patients with acute pulmonary embolism.To observe the characteristics of right ventricular lateral wall strain in patients with different degrees of APTE and to explore the value of 2D-STI technique in quantitative analysis of regional systolic function of right ventricle in patients with different degrees of APTE.Methods: 34 patients with acute pulmonary embolism diagnosed by clinical and CT pulmonary arteriography were divided into three groups according to the clinical criteria: large area APTE(15, sublarge area APTE(10 and non large area APTE(9.30 cases in normal control group.There was no significant difference in PSS between right ventricular lateral wall and apical segment of ventricular septum after treatment compared with control group (P 0.05), but PSS in other segments was lower than that in control group.The difference was statistically significant (P 0.05).In large area APTE patients, the PSS of right ventricular lateral wall was decreased in turn.There was no significant difference in myocardial PSS between large area and sublarge area of APTE in the lateral wall of right ventricle and submembranous segment of the right ventricle (P 0.05), and there was no significant difference between the patients with large area of APTE and that with submembranous basal segment of the right ventricle (P 0.05).The myocardial PSS in the middle segment and the subendocardial apical segment was lower than that in the non-large area group (P 0.05), and the PSS in the submembranous basal segment and the subendocardial apical segment of the second large area APTE group was lower than that in the non-large area group (P 0.05).Conclusion: 1. The PSS of all segments of the right ventricular myocardium in the patients with APTE was decreased, the peak time standard deviation of myocardial strain was increased, but the myocardial strain was still decreased, and the standard deviation of the peak time of strain reached was still higher than that of the control group.Two-dimensional speckle tracing technique can objectively evaluate the therapeutic effect of APTE patients after treatment. 2. 2.The myocardial strain of right ventricular lateral wall was significantly decreased in patients with large area and sub-large area of APTE, and the regional systolic function of right ventricle in APTE patients with different degree of embolism could be quantitatively evaluated by using 2D-STI technique in patients with non-large area APTE.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R445.1;R563.5

【相似文献】