256层CT后门控扫描LVEF测定在急性AD病人心功能评估中的价值

发布时间：2018-09-15 06:42

【摘要】：[目的]通过256层螺旋CT的心功能测定,探讨急性主动脉夹层的发生是否伴有左心室射血分数的减低。CT、心脏超声两种检查方法在射血分数测定上进行量化分析,比较两种方法的相关性及差异性。初步研究主动脉夹层的Stanford不同分型对左心室射血分数小于60%者的左心室射血分数影响的大小。[资料和方法]选择在我院以急诊胸、背或腹部疼痛来院行MSCT全主动脉CTA扫描确诊为AD的病人30例,再对这30例患者行回顾性心脏门控扫描,并重建出心脏搏动周期的0%、40%、45%、75%四个时相的图像,将所有患者四组时相的全部图像传入飞利浦EBW (Extended Brilliance Workspace)工作站,用自身携带的心功能分析软件获取左心室收缩末期(40%)容积、左心室舒张末期(0%)容积,并利用EBW工作站上自带的心功能后处理软件Simpson算法计算出所有病人的LVEF值。统计这30例病人CT及心脏超声分别测定的射血分数值,利用统计软件分析这两组射血分数值之间的相关性及差异性。30例病人中心脏后门控扫描LVEF60%者20例,LVEF60%者10例,再根据主动脉夹层Stanford分型把20例 LVEF60%者分为 Stanford A 型及 Stanford B 型,其中 Stanford A 型 9 例,Stanford B型11例,初步探讨这两种不同分型对所有LVEF60%的患者LVEF值影响的大小。[结果]30例急性主动脉夹层病人均顺利完成心脏后门控扫描及心脏超声检查。1.经心脏后门控扫描测得LVEF60%者有20例,发生率67%,平均年龄(57.95±8.61)岁,LVEF60%者有10例,发生率33%,平均年龄(51.90±8.75)岁。2.CT、心脏超声两种方法测得的LVEF值之间经pearson's correlation统计具有较高的相关性 r=0.765, CT: (58.03± 10.84) %,心脏超声:(60.73 ±5.28) %,经配对t检验示,两种方法测得的计量资料之间统计学无差异(P0.05),相对心脏超声测得的结果,CT对LVEF值的测定有相对偏低倾向,其偏差约(-2.70±7.60) %。3.经心脏后门控扫描并测得LVEF60%患者,其LVEF、年龄符合正态分布,其中StanfordA型9例,平均LVEF: (53.70±3.96) %,平均年龄:(54.89±9.19)岁,Stanford B 型 11 例,平均 LVEF: (49.05 ±2.39) %,平均年龄:(60.09±5.32)岁,上述两组LVEF的比较具有统计学差异(P0.05),年龄对比无统计学差异(P0.05)。[结论](1) MSCT心脏后门控扫描心功能测定能较准确的反映急性AD病人的心功能。(2)急性AD病人的LVEF大多有所减低,MSCTLVEF的测定可作为临床尽早干预心功能的一项参考指标。(3)不同Stanford分型对LVEF60%的急性AD病人的LVEF影响不同。
[Abstract]:[objective] to investigate whether the occurrence of acute aortic dissection is associated with the decrease of left ventricular ejection fraction (LVEF) by measuring the cardiac function of 256-slice spiral CT. The correlation and difference between the two methods were compared. The effect of Stanford classification on left ventricular ejection fraction (LVEF) in patients with left ventricular ejection fraction (LVEF) less than 60% was studied. [materials and methods] Thirty patients with acute chest, back or abdominal pain diagnosed as AD by MSCT total aortic CTA scan were selected, and 30 patients underwent retrospective cardiac gated scan. At the same time, the images of 75% and 75% of the four phases of the heart beat cycle were reconstructed. All the images of all the four groups of patients were transmitted to Philips EBW (Extended Brilliance Workspace) workstation, and the left ventricular end-systolic volume (40%) was obtained by using the cardiac function analysis software carried by themselves. The left ventricular end-diastolic volume (0%) and the LVEF value of all patients were calculated by the Simpson algorithm of cardiac function postprocessing software on EBW workstation. The ejection fraction was measured by CT and echocardiography in these 30 patients. The correlation and difference between the two groups were analyzed by statistical software. Among the 30 patients, 20 cases (10 / 30) with LVEF60% were examined by backdoor scan, and 10 cases (60%) of LVEF were detected by cardiac backdoor scan. According to the Stanford classification of aortic dissection, 20 patients with LVEF60% were divided into Stanford A and Stanford B, of which 9 were Stanford A and 11 were Stanford B. The effect of these two types on LVEF value of all LVEF60% patients was preliminarily investigated. [results] all the 30 patients with acute aortic dissection completed cardiac backdoor scan and echocardiography. There were 20 cases of LVEF60% detected by cardiac backdoor scan, the incidence rate was 67%, the average age was (57.95 卤8.61) years old and 10 cases were LVEF 60%. The incidence rate was 330.The average age was (51.90 卤8.75) years old. 2. The LVEF values measured by two methods of echocardiography had a high correlation with pearson's correlation statistics, r = 0.765, CT: (58.03 卤10.84), echocardiography: (60.73 卤5.28) and T test, respectively. There was no statistical difference between the two methods (P0.05). Compared with the results of echocardiography, CT had a tendency to lower the LVEF value, and the deviation was about (-2.70 卤7.60) .3. The age of LVEF, was normal distribution in 9 cases of StanfordA type, mean LVEF: (53.70 卤3.96), average age of (54.89 卤9.19) years, LVEF: (49.05 卤2.39), mean age of (60.09 卤5.32) years. The LVEF of the above two groups had statistical difference (P0.05), but the age contrast had no statistical difference (P0.05). [conclusion] (1) the measurement of cardiac function by MSCT backdoor scan can accurately reflect the cardiac function of patients with acute AD. (2) the determination of LVEF in patients with acute AD can be used as a reference index for early intervention of cardiac function in patients with acute AD. (3) the effect of different Stanford classification on LVEF in acute AD patients with LVEF60% was different.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.1;R816.2

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