应变率成像和组织速度成像技术对COPD患者右心室功能的评价

发布时间：2018-06-17 03:50

本文选题：慢性阻塞性肺疾病 + 右心室功能　；参考：《泰山医学院》2013年硕士论文

【摘要】：目的研究慢性阻塞性肺疾病（COPD）患者右心室局部及整体功能的受损情况，同时探讨应变率成像和组织速度成像技术评估COPD患者右心室功能的价值。方法入选48例慢性阻塞性肺疾病患者和20例健康对照，采用常规超声技术测量右室前壁舒张末期厚度（RVFT）、右室腔舒张末期前后径（RVEDd）、主肺动脉内径（MPA）、三尖瓣口反流量及右房大小，依据三尖瓣口最大反流速度，同时综合参考三尖瓣口反流量、右房大小来估测肺动脉收缩压（SPA），根据SPA大小将COPD患者分成肺动脉高压组（PAH组）和无肺动脉高压组（NPAH组）。采用定量组织速度成像技术测量三尖瓣环收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）、心房收缩期峰值速度（Va），计算等容收缩期升支斜率IVA、Ve/Va和右室Tei指数。采用应变率成像技术测量右室游离壁各节段收缩期峰值应变（Ss）、收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）、右房收缩期峰值应变率（SRa）。比较各组间上述指标的差异，阐明COPD患者右心室局部及整体功能的受损情况及左室射血分数变化情况，并探讨应变率成像和组织速度成像技术评估COPD患者右心室功能的价值。结果 1. COPD组与健康对照组临床资料比较与健康对照组比较，COPD患者心率显著加快（P＜0.01），吸烟者所占比例明显增高（P＜0.01）。 2. COPD组与健康对照组常规超声测量参数比较与健康对照组比较，PAH组RVFT显著增厚，RVEDd、MPA明显增大，差异有统计学意义（P＜0.01）；NPAH组差异无统计学意义（P＞0.05）。各组间比较，LVEF差异无统计学意义（P＞0.05）。 3.右室局部收缩、舒张功能参数比较与健康对照组比较，NPAH组右室游离壁基底段、中间段的Ss、SRs、SRe、SRa均减低，差异有统计学意义（P＜0.05）；PAH组右室游离壁基底段、中间段的Ss、SRs、SRe、SRa均明显减低，差异有统计学意义（P＜0.01）。与NPAH组比较，PHA组右室游离壁基底段、中间段Ss、SRe明显减低，差异有统计学意义（P＜0.01）；SRs、SRa减低，差异有统计学意义（P＜0.05）。 4.右室整体收缩、舒张功能参数比较与健康对照组比较，NPAH组右室游离壁三尖瓣环处Vs、IVA、Ve、Ve/Va均减低，差异有统计学意义（P＜0.05）；PAH组右室游离壁三尖瓣环处Vs、IVA、Ve、Ve/Va均明显减低，差异有统计学意义（P＜0.01）。与NPAH组比较，PHA组右室游离壁三尖瓣环处Vs、Ve减低，差异有统计学意义（P＜0.05），IVA、Ve/Va减低，差异有统计学意义（P＜0.01）。 5.右室整体功能参数比较与健康对照组比较，NPAH组患者Tei指数增高，差异有统计学意义（P＜0.05）；PAH组患者Tei指数明显增高，差异有统计学意义（P＜0.01）。与NPAH组比较，PHA组患者Tei指数明显增高，差异有统计学意义（P＜0.01）。结论 1. PAH组患者RVFT增厚，RVEDd、MPA增大，提示右室已发生重构；NPAH组患者右室未发生代偿性重构。 2. COPD患者，无论是否伴有肺动脉高压，右室壁局部收缩和舒张功能均明显受损；同时，PAH组右室壁局部收缩和舒张功能受损更重。 3. COPD患者，无论是否伴有肺动脉高压，右室纵向整体收缩、舒张功能明显受损；同时，PAH组患者右室纵向整体收缩和舒张功能受损更重。本研究还显示IVA对COPD患者早期收缩功能损害的敏感性较Vs更高，这可能与IVA相对不依赖前、后负荷，也无心率依赖性有关。 4. NPAH组患者右室整体功能受损；PAH组患者右室整体功能明显受损。 5. COPD患者，无论是否伴有肺动脉高压，心率均增快，而左室射血分数变化不明显。
[Abstract]:Purpose

To investigate the impairment of right ventricular local and integral function in patients with chronic obstructive pulmonary disease ( COPD ) , and to explore the value of strain rate imaging and tissue velocity imaging in evaluating right ventricular function in patients with COPD .

method

The systolic peak strain ( Ss ) , systolic peak strain rate ( SR ) , early diastolic peak strain rate ( SRe ) and systolic peak strain rate ( SRa ) of tricuspid valve were measured by quantitative tissue velocity imaging technique . The difference of systolic peak strain ( Ss ) , systolic peak strain rate ( SR ) , early diastolic peak strain rate ( SRe ) and right atrium systolic peak strain rate ( SRa ) were measured by quantitative tissue velocity imaging technique .

Results

1 . Comparison of clinical data between COPD group and healthy control group

Compared with the healthy control group , the heart rate of COPD patients was significantly faster ( P < 0.01 ) , and the proportion of smokers increased significantly ( P < 0.01 ) .

2 . Comparison of normal ultrasonic measurement parameters between COPD group and healthy control group

Compared with healthy control group , the RVFT of PAH group was significantly increased , RVEDd and MPA increased significantly ( P < 0.01 ) .
There was no significant difference in LVEF between groups ( P > 0.05 ) .

3 . Comparison of local contraction and diastolic function parameters in right ventricle

Compared with the healthy control group , the Ss , SRs , SRe and SRa in the basal segment and middle segment of the right ventricle in the NPAH group were all decreased , and the difference was statistically significant ( P < 0.05 ) .
Compared with NPAH group , there was significant difference in free wall basal segment , middle segment Ss and SRe of PHA group compared with group NPAH group ( P & lt ; 0.01 ) .
There was significant difference between SRs and SRa ( P < 0.05 ) .

4 . Comparison of left ventricular whole systolic and diastolic function parameters

Compared with the healthy control group , there were significant differences in Vs , iva , Ve , Ve / Va at the free wall tricuspid rings in the right ventricle of the NPAH group ( P < 0.05 ) .
Compared with NPAH group , there was a significant difference in Vs , Ve and Ve / Va in the free wall tricuspid rings ( P < 0 . 05 ) , and the difference was statistically significant ( P < 0 . 01 ) .

5 . Comparison of the overall functional parameters of the right ventricle

Compared with the healthy control group , the Tei index of patients with NPAH increased significantly ( P < 0.05 ) .
Tei index in patients with PAH increased significantly ( P & lt ; 0.01 ) . Compared with group NPAH , Tei index in PHA group was significantly higher than that in group NPAH group ( P & lt ; 0.01 ) .

Conclusion

1 . RVFT thickening , RVEDd , MPA increased in PAH group , suggesting that the right ventricle had been reconstructed ;
No compensatory remodeling occurred in the right ventricle of patients in the NPAH group .

2 . In COPD patients , the local contraction and diastolic function of right ventricular wall were significantly damaged , whether with pulmonary hypertension or pulmonary hypertension .
At the same time , the partial contraction and diastolic function of the right ventricular wall of PAH group were more severe .

3 . Patients with COPD , whether or not accompanied with pulmonary hypertension , left ventricular longitudinal whole systolic and diastolic function were obviously damaged ;
At the same time , the longitudinal overall systolic and diastolic dysfunction in the right ventricle of patients with PAH is more impaired . This study also shows that the sensitivity to early systolic function impairment in patients with COPD is higher than that of Vs , which may be associated with the absence of anterior , posterior , or heart rate dependence in patients with COPD .

4 . The whole function of right ventricle was damaged in NPAH group .
The overall function of the right ventricle in patients with PAH was significantly impaired .

5 . Patients with COPD , regardless of pulmonary hypertension , heart rate increased rapidly , and left ventricular ejection fraction was not obvious .
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9;R540.45

【参考文献】