瞬时波强技术在肾移植患者心血管功能评价中的应用研究

发布时间：2018-11-08 12:10

【摘要】：目的： 1．应用瞬时波强(Wave Intensity，WI)[1]技术评价肾移植患者心脏与颈动脉血流动力学变化。 2．瞬时波强技术在肾移植患者心脏及颈动脉血流动力学变化无创估测中的价值。材料和方法： 1.选择2012年6月至2013年12月期间，在我院肾病内科就诊的门诊及住院复查肾移植患者32例，男17例，女15例，年龄为19~68岁，平均(43.16士2.32)岁，均为肾移植术后病情稳定患者。依据术后有无并发症分为两组，即有并发症组（其中血压异常7例，血压＞140/90mmHg；血糖异常6例，空腹血糖≥7.0mmol/l）和无并发症组（19例）。正常对照组32例,男性16例，女性16例，年龄为20~65岁，平均(41.22士2.18)岁，经检查均无高血压、糖尿病、高血脂等。 2.首先选取彩超仪器，要选取装有WI软件的α10型彩色多普勒超声诊断仪，由日本ALOKA公司生产，选择Adult Heart程序，进行常规超声心动图检查，于左室长轴切面测量获得反映左室结构及收缩功能的参数：收缩末期的左室内径(LVEDS)、舒张末期的左室内径(LVEDd)、室间隔舒张末期的厚度(IVST)、左室后壁厚度(PWT)，左室的射血分数（EF)、左室短轴的缩短率(FS)、每搏量(SV)、心输出量(CO)；并通过心尖的四腔心切面获得左室舒张功能相应值（舒张早期与晚期峰值速度E峰、A峰）及E/A。上述所有参数，要分别测量三次，然后计算平均数，并记录数据和存储图像。进入WI程序后，描记获得随心动周期运动的右侧颈总动脉管壁的轨迹，，进而得到WI参数：瞬时加速度波强(Wl， AcceleratingWave Intensity)、负向波面积(NA，NnegativeArea)、瞬时减速度波强(W2，Decelerating Wave Intensity)、动脉弹性参数—颈动脉僵硬度（β，Stiffness）、血管的压力-应变弹性系数（Ep，Contingency coefficient of Pressure）、颈动脉顺应性（AC，Compliance）、增大指数（AI， Augmentation index）、脉搏波传导速度（PWVβ，Pulse Wave Velocity）等多项WI曲线参数，分析肾移植患者的WI曲线特征及表现规律，探讨WI技术在无创性评价肾移植患者心脏和动脉系统的血流动力学表现和相互关系方面的应用价值。结果: (1).一般资料比较:肾移植术后有并发症组、肾移植术后无并发症组、正常对照组的年龄、身高、体重、体表面积及身体质量指数差异比较，p0.05，均无统计学意义；肾移植术后有并发症组分别与肾移植术后无并发症组和正常对照组收缩压、舒张压、平均压的差异比较，p均0.01有显著意义。 (2).常规超声心动图检查参数比较：肾移植术后有并发症组分别与肾移植术后无并发症组、正常对照组的LVEDS、LVEDd、I VST、PWT指标差异比较，p0.05有统计学意义；肾移植无并发症组与正常对照组的LVEDS、LVEDd、I VST、P WT指标差异比较，p0.05无统计学意义；肾移植有并发症组、肾移植无并发症组、正常对照组EF、FS、SV、CO差异分别比较，p0.05无统计学意义；肾移植有并发症组、肾移植无并发症组与正常对照组E峰差异比较，p0.05有统计学意义；三组间E/A比值、A峰的差异比较，p0.05无统计学意义。 (3).WI技术各参数比较：肾移植术后有并发症组与肾移植术后无并发症组β、Ep、PWVβ均高于对照组,差异有统计学意义(p 0.05)；肾移植术后有并发症组W1、W2、NA明显高于无并发症组和对照组,差异有统计学意义(p 0.05)；三组间AC和AI无明显差异。结论： WI系统通过实时测量动脉管径和动脉内血流速度变化，可以在动脉硬化早期，综合评估动脉管壁的柔韧性和心脏功能，WI技术具有原始数据的实时采集、重复性好、无创性、精确度高等优点，为临床筛查、随访和评价治疗效果提供定量、WI相关数据进而得到关于心脏和颈动脉系统之间的相关性，是一种研究肾移植患者客观的有利依据，进而为临床治疗提供指导；本文经过统计、研究肾移植患者的颈动脉的心功能的全新方法。
[Abstract]:Purpose: 1. The hemodynamics of the heart and the carotid artery in the patients with renal transplantation was evaluated by the wave intensity (WI)[1] technique. changes of the dynamic changes of blood flow in the heart and carotid artery in the patients with renal transplantation The value in the test. Materials and Methods: 1. During the period from June 2012 to December 2013, 32 cases of renal transplantation were reviewed in the clinic and in-hospital of the nephrology department of our hospital. There were 17 males and 15 females. The age ranged from 19 to 68 years. The average was 43. 16 (2. 32) years. The patients with stable condition after renal transplantation were divided into two groups according to the postoperative complications, namely, the complication group (in which the blood pressure was abnormal in 7 cases, the blood pressure was more than 140/ 90mmHg, the blood glucose was abnormal in 6 cases, and the fasting blood glucose was 7.0mmol/ l). and there were no complications (19 cases). The normal control group (n = 32), male (16), female (16), age (20-65), average (41. 22 + 18) years, no high examination. Blood pressure, diabetes, hyperlipidemia, and the like. First, select the color Doppler ultrasound instrument, select the color Doppler ultrasonic diagnostic instrument with the WI software, select the Ault Heart procedure by the Japanese ALOHKA company, conduct routine echocardiogram, and obtain the measurement of the long axis section of the left chamber. Parameters reflecting the structure and contraction function of the left chamber: the left ventricular diameter (LVEDS) at the end of the contraction, the left ventricular diameter (LVEDd) at the end of the diastole, the thickness (IVST) at the end of the interventricular septum, the thickness of the posterior wall of the left chamber (PWT), the ejection fraction (EF) of the left chamber, the shortening of the short axis of the left chamber (FS), each stroke Volume (SV), cardiac output (CO); and the corresponding value of the left ventricular diastolic function (early and late diastolic) is obtained through the four-lumen heart-cut surface of the apex Peak speed E (peak, peak A) and E/ A. All of the above parameters are measured three times and then calculated The average number and the recorded data and stored images were recorded. After entering the WI procedure, the trace of the right neck total artery wall with the motion of the cardiac cycle was obtained, and the WI parameters were obtained: the instantaneous acceleration wave intensity (Wl, the Acceleration Wave Intensity), the negative-to-wave area (NA, NnegativeArea), the instantaneous deceleration wave (W2, Decelerating). Wave Intensity, arterial elasticity parameters, carotid stiffness, arterial compliance (Ep, Conforming efficiency of Pressure), carotid compliance (AC, Compliance), augmentation index (AI, Augmentation index), pulse wave conduction velocity (PWV), Pulse Wave Velo The characteristics of the WI curve and the performance of the kidney transplantation were analyzed, and the blood flow dynamics of the heart and the arterial system in the patients with renal transplantation were evaluated by using the WI technique. performance and mutual relationship The results were as follows: (1): (1) There were no complications after renal transplantation, no complication group after renal transplantation, age, height, body weight, body surface area and body mass of normal control group. There was no significant difference in the index difference and p0.05, and there was no significant difference between the postoperative complication group and the normal control group after the kidney transplantation. average pressure (2) There were no complications after renal transplantation, LVEDS, LVEDd, I VST and PWT in the normal control group were significantly different. Compared with LVEDS, LVEDd, I VST and P WT in the normal control group, there was no statistical significance in p0.05. There were no complications in renal transplantation, no complication group in kidney transplantation, EF, FS, SV and CO in the normal control group, respectively. There was no statistical significance in p0.05. There was no significant difference between the two groups of renal transplantation and the normal control group, and p0.05 was of statistical significance. There was no significant difference in the ratio of A and A. (3) There was no statistical significance in p0.05. (3) Compared with the control group, there was no complication group after renal transplantation, and the difference of Ep and PWV was higher than that in the control group (p <0.05). The incidence of W1, W2 and NA in the complication group was significantly higher than that of the non-complication group and the control group. statistics Conclusion: WI system can evaluate the flexibility and heart function of the arterial wall in the early stage of arteriosclerosis by measuring the arterial diameter and the velocity of the blood flow in the artery in real time. The WI technology has the advantages of real-time acquisition of raw data, good repeatability, no invasive, high accuracy and the like, and provides quantitative and WI-related data for clinical screening, follow-up and evaluation of the treatment effect, so as to obtain the correlation between the heart and the carotid artery system, and is a research and development method. To investigate the objective and beneficial basis of renal transplantation, and to provide clinical treatment
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2;R54

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