实时三维超声心动图及斑点追踪技术评价老年房颤患者心脏结构、血流和功能特点

发布时间：2018-04-22 22:17

本文选题：实时三维超声心动图 + 三维斑点追踪技术　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:1、探讨实时三维超声心动图(RT-3DE)及三维斑点追踪技术(3D-STI)评价老年心房颤动患者左心室容积及泵血功能的价值。2、应用实时三维超声新技术联合三尖瓣环收缩期位移(TAPSE)及下腔静脉塌陷率(△IVC)评估老年房颤患者右室结构与收缩功能变化。方法:选取80例持续性孤立性房颤病史大于20年的老年患者为病例组(B组),平均年龄约81.2岁;同期80例健康体检老年人为对照组(A组),平均年龄约79.9岁。1、测量A、B两组常规超声参数:左房舒张末期最大面积(LAA)、左心室舒张末期最大内径(LVDd)、Simpson法左心室射血分数(LVEF)、二尖瓣反流面积(MRA),并计算MRA/LAA面积百分比、室间隔厚度(IVSTd)、左心室收缩末期最小内径(LVDs)、左心室舒张功能指标E/E,、右房舒张末期最大面积(RAA);右心室舒张末期基底部横径(Basal RVd)、三尖瓣反流面积(TRA),并计算TRA/RAA面积百分比、肺动脉收缩压(PASP)、右室面积变化分数(RVFAC)、右心室舒张功能指标e/e,、三尖瓣环收缩期位移(TAPSE)及下腔静脉塌陷率(△IVC)。2、测量A、B两组实时三维超声参数:左心室收缩末期最小容积(LVESV)、左心室射血分数(RT-LVEF)、左心室舒张末期最大容积(LVEDV);右室收缩末期最小容积(RVESV)、右室射血分数(RVEF)、右室舒张末期最大容积(RVEDV)。3、测量A、B两组三维斑点追踪成像参数:左心室整体面积收缩期峰值应变(LVGAS)、左心室整体纵向收缩期峰值应变(LVGLS)、左心室整体圆周收缩期峰值应变(LVGCS)、左心室整体径向收缩期峰值应变(LVGRS)。结果:1、常规二维超声测量结果:病例组B组与参照组A组相比,LVDs、IVSTd、PWd无明显变化(P均0.05);LVDd、LAA、MRA、E/E’、BasalRVd、TRA、RAA、PASP、e/e’、MRA/LAA、TRA/RAA呈升高趋势,差异有统计学意义(P0.05或0.01);RVFAC、TAPSE、△IVC、LVEF有减低趋势,差异有统计学意义(P0.05)。2、三维实时超声技术测量结果:病例组B组与参照组A组相比,LVEDV、LVESV、RVEDV、RVESV呈增大趋势,差异有统计学意义(P0.05或0.01);RT-LVEF、RVEF有减低趋势,差异有统计学意义(P0.05或0.01)。3、三维超声斑点追踪技术测值结果:LVGLS、LVGCS、LVGRS、LVGAS绝对值有减低趋势,差异有统计学意义(P0.05或0.01)。结论:1.长期心律控制不佳的老年房颤患者心脏结构及功能发生变化,表现为双房明显增大,左右心室容积增加,心脏收缩及舒张功能均降低,左心室各方向应变值均减低;三尖瓣反流较二尖瓣反流明显,肺动脉压力增高。2.实时三维超声心动图及三维斑点追踪成像技术能够对老年心房颤动患者左右心室容积及泵血功能进行评估。在临床诊断、治疗、判断病情进展及预后中有一定参考价值。
[Abstract]:Objective to evaluate the value of real-time three-dimensional echocardiography RT-3DEand 3D speckle tracing technique in evaluating left ventricular volume and blood pump function in elderly patients with atrial fibrillation. Methods A new real-time three-dimensional echocardiography combined with systolic position of tricuspid annulus was used to evaluate the left ventricular volume and blood pump function in elderly patients with atrial fibrillation. The changes of right ventricular structure and systolic function in elderly patients with atrial fibrillation were evaluated by TAPSE and IVC. Methods: 80 elderly patients with persistent solitary atrial fibrillation for more than 20 years were selected as group B with an average age of 81.2 years. During the same period, 80 healthy elderly persons were treated as control group A, with an average age of 79.9 years. The parameters of conventional echocardiography in two groups were measured: left atrial end diastolic maximum area (LAA), left ventricular end-diastolic maximum diameter (LVDdU) and left ventricular ejection fraction (LVEFV). Mitral regurgitation area (MRAA) and MRA/LAA area percentage were calculated. The left ventricular septal thickness, left ventricular end systolic minimum diameter, left ventricular diastolic function index E / E, right atrial end diastolic maximum area, right ventricular end diastolic base transverse diameter and tricuspid regurgitation area were calculated, and the percentage of TRA/RAA area was calculated. Pulmonary artery systolic pressure (PAP), right ventricular area change fraction (RVFAC), right ventricular diastolic function index (E / E), tricuspid annular systolic displacement (TAPSE) and inferior vena cava collapse rate (IVCV) were measured in two groups: left ventricular end-systolic minimum. Left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDVV), right ventricular end-systolic minimum volume (RVESVV), right ventricular ejection fraction (RVEFV), right ventricular end-diastolic maximum volume (RVEDVV), right ventricular end-diastolic volume (RVEDVV). The peak systolic strain of whole ventricular area is LVGASA, the peak strain of left ventricular whole longitudinal systolic period is LVGLSN, the peak strain of left ventricular whole peripheral systolic period is LVGCSC, and the peak strain of left ventricular whole radial systolic period is LVGRSs. Results: compared with control group A, there was no significant change in LVDsSV IVSTdT PWD in case group B and control group A (P < 0.05). There was a trend of decrease in IVC LVEF, and there was a trend of decrease in IVC LVEF, and there was a trend of increase in RVFACTAPSE.IVCLVEF was decreased in group B (P 0.05, P 0.05 or P < 0.05), but there was a trend of decrease in LVEF in IVC LVEF, and there was no significant difference between group B and group A (P > 0.05) in the results of routine two-dimensional ultrasound measurements of two dimensional ultrasound. The results showed that there was a tendency to increase in group B, and there was a significant difference between group B and group A (P 0.05 or P 0.05). There was a significant difference in RVESV between group B and group A, and the RVESV of RVEVV in group B was significantly higher than that in group A, and the difference was significant (P0.05) or 0.01% (RT-LVEFV / RVEF), and the RVESV of RVEVEF in group B was significantly lower than that in group A (P < 0.05), and there was a decrease in RVESV between group B and group A (P < 0.05). The results showed that the absolute value of LVGRSs in LVGCSN / LVGCSN / LVGRSs / LVGAS decreased significantly, and the difference was statistically significant (P0.05) or 0.01g / L (P < 0.05). The results showed that the absolute value of LVGRSs in LVGRSs was significantly lower than that in the control group (P < 0.05). Conclusion 1. The changes of cardiac structure and function in elderly patients with chronic atrial fibrillation were as follows: the volume of left and right ventricle increased, the volume of left and right ventricle increased, the systolic and diastolic function of the left ventricle decreased, and the strain values of left ventricle decreased in all directions. Tricuspid regurgitation was more obvious than mitral regurgitation, and pulmonary artery pressure was higher than that of mitral regurgitation. Real-time three-dimensional echocardiography and three-dimensional speckle tracing imaging can be used to evaluate left and right ventricular volume and blood pump function in elderly patients with atrial fibrillation. It has certain reference value in clinical diagnosis, treatment, judgement of disease progress and prognosis.
【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】：R541.75;R540.45

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