实时三维超声心动图对缺铁性贫血患者左心房功能的评价

发布时间：2018-02-08 09:58

本文关键词： 左心房功能实时三维超声心动图缺铁性贫血　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用实时三维超声心动图(RT-3DE)评价缺铁性贫血患者左心房功能。方法:选取2014年11月至2016年4月来自我院血液科、妇产科、消化科住院患者65例,贫血时间均6个月以上,将65名患者的血红蛋白浓度(Hb)分为B、C两组,B组:血红蛋白(Hb)90 g/L(年龄25~65岁,平均年龄48.8±14.1岁,病程7个月~15年);C组:血红蛋白(Hb)60~90 g/L(年龄22~62岁,平均年龄47.6±16.6岁;病程8个月~14年)。其中由妇科疾病如子宫肌瘤、腺肌症、月经量增多导致的贫血的患者38例,由消化系统疾病如胃大部分切除术导致的贫血的患者18例,由其他原因导致的IDA原因待查的患者9例。B、C两组贫血患者均为临床确诊为缺铁性贫血患者,排除先天性因素、糖尿病、冠心病、甲亢、高血压等导致的心脏病,排除胃肠道恶性肿瘤术后接受化疗、放疗的患者,也排除有家族病史及其他慢性病史。另外选取30名在我院体检的正常健康人(年龄23~64岁,平均年龄47.0±14.5岁)作为对照组(A组),正常健康人组无家族病史及其他病史,且体格检查、心电图、胸片、超声心动图及血液实验室化验指标均正常。应用美国GE公司出产的Vivid E9彩色多普勒超声诊断设备,配备了M5S-D探头(频率1.5~4.5 MHz)及4V-D探头(频率1.7~3.3 MHz),并且配备了相关分析软件。常规二维超声以及RT-3DE所测量数据参数如下。1.常规记录被检查者性别、年龄、心率、血压。嘱被检查者均取左侧卧位,平静呼吸,首先对各组被检查者进行常规经胸超声心动图检查,完成二维图像采集及所需参数测量,主要包括左心房收缩末期前后径(LADs)、左室舒张末期内径(LVDd)、舒张末期室间隔厚度(IVSTd)、舒张末期左室下侧壁厚度(PWTd)。频谱多普勒测量参数主要包括二尖瓣瓣口E峰、A峰血流速度及E/A比值。2.对各组被检查者应用RT-3DE对左心房相关参数进行测定。三维测定参数主要包括左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房主动收缩前容积(LAVp),用体表面积(BSA)将以上数据进行校正,得出左心房容积指数LAVImax、LAVImin、LAVIp,计算左心房射血分数(LAEF)、左心房被动射血分数(LAPEF)、左心房主动射血分数(LAAEF)。结果:1.常规超声测量结果显示:B组所有数据与A组所有数据对比无统计学意义(均P0.05)。C组LADs、A峰与A组、B组比较均增大(均P0.05),E峰、E/A减小(均P0.05)。2.RT-3DE测量结果显示:B组所有数据与A组所有数据对比无统计学意义(均P0.05)。C组LAAEF、LAVIp、LAVImax、LAVImin与A、B组比较明显增大(均P0.05),LAPEF、LAEF显著减低(均P0.05)。结论:RT-3DE可以有效地评估缺铁性贫血患者的左心房功能。
[Abstract]:Objective: to evaluate the left atrial function in patients with iron deficiency anemia by real-time three-dimensional echocardiography (RT-3DE). Methods: from November 2014 to April 2016, 65 inpatients from hematology department, obstetrics and gynecology department and digestive department in our hospital were selected, and the anemia time was more than 6 months. The hemoglobin concentration of 65 patients was divided into two groups: group B: hemoglobin B group: hemoglobin Hb1 90g / L (mean age: 48.8 卤14.1 years old, 25 ~ 65 years old). The course of disease ranged from 7 months to 15 years in group C: hemoglobin HbBX 60g / L (22 ~ 62 years old, mean age 47.6 卤16.6 years); The course of disease ranged from 8 months to 14 years. Among them, 38 cases were anaemia caused by gynecological diseases such as hysteromyoma, adenomyosis and increased menstrual volume, and 18 cases were anemia caused by digestive system diseases such as gastrectomy. Nine patients with IDA caused by other causes, all of whom were clinically diagnosed with iron deficiency anemia, were excluded from congenital factors, diabetes, coronary heart disease, hyperthyroidism, hypertension, etc. Patients who received chemotherapy and radiotherapy after operation for gastrointestinal malignancies were also excluded from family history and other chronic diseases. Another 30 healthy persons (aged 23 to 64 years) who were examined in our hospital were selected. The average age was 47.0 卤14.5 years old) as control group A group, normal control group had no family history and other medical history, and physical examination, electrocardiogram, chest radiography, Echocardiography and blood laboratory tests were normal. Vivid E9 color Doppler ultrasound diagnostic equipment produced by GE Company was used. The M5S-D probe (frequency 1.5mm 4.5 MHz) and the 4V-D probe (frequency 1.73.3 MHz) were equipped with correlation analysis software. The parameters measured by conventional two-dimensional ultrasound and RT-3DE were as follows: 1. Routine recording of sex, age, heart rate, Blood pressure. The subjects were told to take the left supine position and breathe calmly. First of all, routine transthoracic echocardiography was performed to collect the two-dimensional images and measure the required parameters. The main parameters include left atrial anterior and posterior diameter LADsN, left ventricular end diastolic diameter (LVDdN), end diastolic septal thickness (IVSTD) and left ventricular inferior wall thickness (PWTdN). Spectral Doppler parameters mainly include mitral valve orifice E peak A blood flow. Velocity and E / A ratio .2.The parameters related to left atrium were measured by RT-3DE in each group. The three dimensional parameters mainly include left atrium maximal volume, left atrial minimum volume, left atrial active presystolic volume, left atrial active presystolic volume and body surface. Area BSA) to correct the above data, The left atrial volume index (LAVImax1 / LAVImin1 / LAVIp) was obtained, the left atrial ejection fraction (Laff), the left atrial passive ejection fraction (LAPEFG) and the left atrial active ejection fraction (LAAEFN) were calculated. Results: 1. Routine ultrasound measurements showed that all data in Group B were not consistent with those in Group A. Statistical significance (all P0.05 + .C group compared with group A and A group) increased (P 0.05) E peak E / A decreased (P0.05 + 2.RT-3DE results showed that there was no statistical significance between all data of group B and group A (all P0.05.C group LAAEFLAVIpImaxLAVImin and Aneb group). The results showed that there was no significant difference between group A and group A (all P0.05.C group). The results showed that there was no statistical significance between group A and group A (all P0.05.C group). The results showed that there was no statistical difference between group A and group A (all P0.05.C group). Large (P0.05) LAPEFLAEF was significantly decreased (P 0.05). Conclusions: RT-3DE can effectively evaluate the left atrial function in patients with iron deficiency anemia.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R556.3;R540.45

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