超声斑点追踪成像对CABG患者左心功能的研究分析

发布时间：2018-12-10 13:46

【摘要】：目的:1.应用超声斑点追踪成像(Ultrasound speckle tracking imaging,STI)技术测量左心室应变指标研究CABG患者术前与术后左心室功能的变化;2.应用超声斑点追踪成像技术研究左心房应变指标与术后心房颤动(Atrial fibrillation,AF)的相关性。方法:选取2016年1月1日-2016年10月31日期间河北大学附属医院心脏外科住院行CABG患者53例,并选择同期入院检查的50例正常人做为对照组。1.应用常规经胸超声心动图分别对正常人及患者在行CABG术前、术后4-7d、术后1个月测量室间隔厚度(IVST)、左心室前后径、左室射血分数(LVEF);应用STI技术分别对正常人及患者在行CABG术前、术后4-7d、术后1个月进行左心室功能指标变化的监测并进行对比分析;2.应用常规经胸超声心动图分别对正常人及患者在行CABG术前测定左心房前后径(LAD)、舒张早期二尖瓣跨瓣血流速度(E)、舒张晚期二尖瓣跨瓣血流速度(A)、E/A;应用STI技术分别对正常人及患者在行CABG术前测量左心室收缩期左心房长轴方向整体应变(Ss)、左心房收缩期左心房长轴方向整体应变(Sa)以及左心房各节段应变率(SRs)。对患者术后进行连续的心电监测,至少72小时。结果:(1)应用STI技术比较两组间在二腔心切面、四腔心切面以及三腔心切面整体应变值的绝对值,CABG患者左心室的整体应变值较对照组减低,术后组随桥血管血供时间的延长,各节段整体应变值比术前组升高,差异有统计学意义(P0.05);(2)与对照组比较,术后房颤组所测指标,E较高,A较低,E/A较高,差异无统计学意义(P0.05),LAD较大,Ss、Sa、SRs均较低,差异有统计学意义(P㩳0.05);(3)与对照组比较,术后非房颤组各项指标与其差异无统计学意义(P0.05);(4)术后房颤组与非房颤组比较,Ss、Sa、SRs均较低,差异有统计学意义(P㩳0.05)。结论:(1)STI技术能无创及定量地评价CABG患者左心室舒缩功能的异常,为CABG术前、术后左心室功能的研究评价提供了强有力的新工具;(2)术前应用STI技术所测得的左心房应变值与CABG术后新发房颤具有明显的相关性,当LAD、BMI较高时,Ss、Sa、SRs较低时术后容易发生房颤,提示LAD、BMI、Ss、Sa、SRs均为影响CABG术后是否发生房颤的危险因素。
[Abstract]:Objective: 1. The changes of left ventricular function in patients with CABG before and after operation were studied by measuring left ventricular strain index by (Ultrasound speckle tracking imaging,STI. 2. The correlation between left atrial strain index and postoperative atrial fibrillation (Atrial fibrillation,AF) was studied by using ultrasonic speckle tracing imaging. Methods: from January 1, 2016 to October 31, 2016, 53 patients with CABG in cardiac surgery department of Hebei University affiliated Hospital were selected, and 50 normal subjects were selected as control group. The left ventricular diameter, left ventricular ejection fraction (LVEF);) and left ventricular septal thickness (IVST),) were measured by conventional transthoracic echocardiography before CABG, 4-7 days after CABG and 1 month after operation. STI technique was used to monitor and compare the changes of left ventricular function indexes in normal subjects and patients before and after CABG for 4-7 days and 1 month postoperatively. 2. Conventional transthoracic echocardiography was used to measure the early mitral flow velocity (A), E / A) before left atrial anterior and posterior diameter (LAD), relaxation in normal subjects and patients before CABG. (E), late diastolic mitral valve velocity (A), E / A); STI technique was used to measure the global strain of left ventricular systolic left atrium long axis direction (Ss), and left atrial long axis strain (Sa) and left atrial strain rate (SRs). Before CABG. Continuous ECG monitoring was performed after operation for at least 72 hours. Results: (1) STI technique was used to compare the absolute values of the global strain between the two groups on the two-chamber, four-chamber and three-chamber central sections. The global strain of the left ventricle in CABG patients was lower than that in the control group. With the prolongation of blood supply time, the global strain value of each segment in the postoperative group was higher than that in the preoperative group, the difference was statistically significant (P0.05). (2) compared with the control group, the indexes of postoperative atrial fibrillation group were higher E, lower A and higher E / A, the difference was not statistically significant (P0.05), LAD was larger, Ss,Sa,SRs was lower, the difference was statistically significant (P0. 05); (3) compared with the control group, there was no significant difference between the indexes of postoperative non-atrial fibrillation group and the control group (P0.05); (4). Compared with the non-atrial fibrillation group, the Ss,Sa,SRs of postoperative AF group was lower, and the difference was statistically significant (P0. 05). Conclusion: (1) STI technique can be used to evaluate the left ventricular systolic and diastolic function of CABG patients in a noninvasive and quantitative manner, which provides a powerful new tool for the study and evaluation of left ventricular function before and after CABG. (2) there was a significant correlation between the left atrial strain measured by STI technique before operation and new atrial fibrillation after CABG. When LAD,BMI was higher, atrial fibrillation was easy to occur when Ss,Sa,SRs was lower, indicating that LAD,BMI,Ss,Sa, was easy to occur after operation. SRs was a risk factor for atrial fibrillation after CABG.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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