原发性高血压患者左室收缩同步性与Tpe间期关系的初步研究

发布时间：2018-03-26 06:33

本文选题：超声心动描记术　切入点：实时三维　出处：《安徽医科大学》2016年硕士论文

【摘要】：背景原发性高血压是心血管疾病的常见病。长期高血压导致心肌发生重构,心肌收缩同步性的下降,进而引起收缩功能下降,同时心室跨壁复极离散度(TDR)增加,使室性心律失常更易发生。有研究发现肥厚性心肌病患者室性心律失常发生率增加。而且左室收缩同步性下降及心室跨壁复极离散度增加,二者之间存在相关性。而原发性高血压中,左室收缩同步性下降及心室跨壁复极离散度之间关系研究报道较少。实时三维超声心动图(RT-3DE)作为检测心脏功能的新兴手段,能实时、立体、准确反映心室运动情况,定量评价左心室收缩同步性。因此本文采用RT-3DE作为检测高血压患者心室收缩同步性的技术手段。Tpe间期是指T波顶峰至T波结束的时间,最近被提出作为衡量TDR的新指标。故本文采用Tpe间期反映TDR。即本文采用RT-3DE及Tpe间期反映原发性高血压中左室收缩同步性与TDR的关系。目的研究原发性高血压患者的左室收缩同步性与Tpe间期的关系。方法选取原发性高血压患者196例(正常构型组44例、向心型重构组45例、向心型肥厚组58例、离心型肥厚组49例)和健康体检者40例(正常对照组)。采用实时三维超声心动图(RT-3DE)获得左心室收缩同步性相关参数:左心室16节段经心率校正后达到收缩末期最小容积时间的标准差(Tmsv16-SD%,即SDI)以及最大时间差(Tmsv16-Dif%,即DIF)。根据心电图获得Tpe间期、校正Tpe间期(Tpec)。比较各组间差异并分析SDI、DIF分别与Tpe间期、Tpec之间的相关性。结果与正常对照组比较,正常构型组SDI、DIF增大(P㩳0.05),Tpe间期及Tpec差异无统计学意义;向心型重构组除Tpec外,余参数均增大(P㩳0.05);向心型肥厚组及离心型肥厚组各参数均增大(P㩳0.05)。与正常构型组比较,向心型重构组各参数差异无统计学意义;向心型肥厚组及离心型肥厚组各参数均增大(P0.05)。与向心型重构组比较,向心型肥厚组及离心型肥厚组各参数均增大(P㩳0.05)。与向心型肥厚组比较,离心型肥厚组各参数均增大(P㩳0.05)。SDI、DIF分别与Tpe间期及Tpec呈正相关性(r=0.56、0.50,0.44、0.52,P㩳0.01)。结论在原发性高血压患者中,随着重构加重,左室收缩不同步性与Tpe间期逐渐增加,且左室收缩不同步性与Tpe间期呈正相关性。
[Abstract]:Background essential hypertension is a common disease of cardiovascular disease. Long-term hypertension leads to myocardial remodeling, myocardial contraction synchronism decline, which leads to the decline of systolic function, and the increase of transmural dispersion of ventricular repolarization (TDRR). The incidence of ventricular arrhythmias was increased in patients with hypertrophic cardiomyopathy, and left ventricular systolic synchrony decreased and ventricular transmural repolarization dispersion increased. In essential hypertension, however, there are few studies on the relationship between left ventricular systolic synchrony decline and ventricular transmural repolarization dispersion. Real-time three-dimensional echocardiography (RT-3DEE) can be used as a new method to detect cardiac function in real time. Stereoscopic, accurate reflection of ventricular motion and quantitative evaluation of left ventricular systolic synchrony. Therefore, RT-3DE is used as a technical means to detect ventricular systolic synchrony in hypertensive patients. Tpe interval refers to the time from the peak of T wave to the end of T wave. Recently, it has been proposed as a new index to measure TDR. In this paper, Tpe interval is used to reflect TDR. In this paper, RT-3DE and Tpe intervals are used to reflect left ventricular systolic synchronism in essential hypertension. Objective to study the relationship between left ventricular systolic synchronism and TDR in patients with essential hypertension. Methods 196 patients with essential hypertension (normal group, 44 cases) were selected. There were 45 cases in concentric remodeling group and 58 cases in concentric hypertrophy group. Centrifuge hypertrophy group (49 cases) and healthy control group (40 cases) (normal control group). Using real-time three-dimensional echocardiography (RT-3DED) to obtain the left ventricular systolic synchronism related parameters: left ventricular 16 segments after heart rate correction to the end systolic maximum. The standard deviation of small volume time is Tmsv16-SDI, and the maximum time difference is Tmsv16-Dif.According to the electrocardiogram, the Tpe interval is obtained. The correlation between Tpe and Tpe interval was analyzed. Results compared with the normal control group, the SDII-DIF of the normal configuration group increased the level of Tpec, and compared with the normal control group, the SDII-DIFs increased the difference between the two groups, and analyzed the correlation between the SDII-DIF and the Tpe interphase. There was no significant difference in TPE interval and Tpec between 0. 05 and 0. 05% TPE interval. In the concentric remodeling group, the other parameters increased except Tpec. The parameters of concentric hypertrophy group and centrifugal hypertrophy group were increased. There was no significant difference in the parameters between the concentric remodeling group and the normal configuration group, but the parameters of the concentric type hypertrophy group and the centrifugal type hypertrophy group were all increased, compared with the concentric remodeling group, and that of the concentric remodeling group was higher than that of the concentric remodeling group. The parameters of concentric hypertrophy group and centrifugal hypertrophy group were increased. Compared with concentric hypertrophy group, the parameters of centrifugal hypertrophy group were increased. DIF was positively correlated with Tpe interval and Tpec. Conclusion in patients with essential hypertension, left ventricular systolic heterogeneity and Tpe interval gradually increased with the exacerbation of remodeling, and left ventricular systolic heterogeneity was positively correlated with Tpe interval.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R544.11

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