我爱论文网 >> 论文中心 >> 超声应变显像在房间隔缺损封堵术中的应用

超声应变显像在房间隔缺损封堵术中的应用

2017-11-10 07:00:04    作者:admin    www.5alw.com

【摘要】  目的 应用超声应变显像技术(SI)评价房间隔缺损(ASD)封堵术前、术后心脏功能的变化。方法选取接受Amplataer封堵器治疗的继发孔型ASD病人50例,分别于ASD封堵术前3 d、术后1周、术后3个月,应用SI在心尖四腔切面测量各房室腔大小、肺动脉收缩压(PASP),右室侧壁三尖瓣环处、右室侧壁中部、室间隔二尖瓣环处、室间隔中部、左室侧壁二尖瓣环处以及左室侧壁中部收缩期峰值应变(Ss)。选择健康志愿者50例作为对照组。结果 与对照组比较,ASD组右心房(RA)横径、右心室(RV)横径、PASP增大,差异有显著性(t=2.23~2.87,P<0.05);与术前比较,术后1周RA横径、 RV横径、 PASP显著减小,术后3个月RA横径、 RV横径、PASP进一步减小,差异有显著性(F=7.58~13.46,q=3.50~3.98,P<0.05)。与对照组比较,ASD组术前右室壁和室间隔、左室侧壁二尖瓣环处Ss显著增大,差异有显著性(t=2.04~2.97,P<0.05)。与封堵术前比较,术后1周右室侧壁、室间隔中部Ss均显著降低(F=8.57~14.66,q=3.67~4.90,P<0.05),术后3个月右室侧壁、室间隔和左室壁Ss均显著降低(q=3.46~3.86,P<0.05);与封堵术后1周比较,术后3个月右室侧壁中部Ss显著降低(F=14.59,q=3.46,P<0.05)。结论 SI可准确、定量评价房间隔缺损封堵术前、术后心脏功能的变化,评价封堵术的治疗效果。 
【关键词】  超声心动描记术;心脏导管插入术;房间隔缺损;治疗结果
  [ABSTRACT]ObjectiveTo assess cardiac function by strain imaging (SI) in patients with atrial septal defects (ASD) undergoing device closure.MethodsFifty patients with secondary isolated ASD undergoing device closure and 50 healthy controls were enrolled in this study. Using SI technique, the transverse diameters (TD) of all chambers and pulmonary artery systolic pressure (PASP) were measured at the apex of heart, and the systolic strain peaks (SSPs) were measured in tricuspid annulus, middle part of right ventricle (RV), mitral annulus, middle part of ventricular septum, mitral annulus and middle part of left ventricle (LV), three days before, one week and three months after the procedure.ResultsCompared with the controls, the TD of right chambers and PASP in the patients were significantly increased (t=2.23-2.87,P<0.05); compared with pre?surgery, the above parameters were decreased one week after the closure, which were further decreased three months later (F=7.58-13.46,q=3.50-3.98,P<0.05). The SSPs of RV wall, of ventricular septum and mitral annulus of LV were significantly increased before defect closure, compared with that of the controls (t=2.04-2.97,P<0.05). The SSPs of RV wall and the middle part of ventricular septum were decreased one week after the procedures (F=7.58-13.46,q=3.67-4.90,P<0.05). The SSPs of the RV wall, the ventricular septum and the LV wall decreased further after three months (q=3.50-3.98,P<0.05). The SSPs of the middle part of RV were significantly lower three months after device closure than one week after that (F=14.59,q=3.46,P<0.05).ConclusionStrain imaging can accurately and quantitatively evaluate the cardiac function changes in patients before and after ASD closure.
    [KEY WORDS]Echocardiography; Heart catheterization; Atrial septal defects; Treatment outcome
    超声应变显像技术(SI)是在定量组织多普勒基础上发展起来的新技术,时间分辨率高,能够同时定量分析多节段心肌运动,将局部心肌功能的检测提高到了一个新台阶[1]。本研究应用SI观测房间隔缺损(ASD)封堵病人术前和术后心肌部分节段参数变化以评价其疗效及恢复情况,现报告如下。
  1  资料和方法
  1.1  一般资料
    2006年3月~2007年3月,选取50例继发孔型ASD病人,其中男23例,女27例;年龄18~50岁,平均(39.6±12.1)岁,均用Amplatzer封堵器治疗。ASD大小为1.0~3.0 cm,平均(1.8±0.4)cm。全部病人均为窦性心律,除外心律失常、其他先天性心脏病、瓣膜病及慢性阻塞性肺疾病等病人。同时,根据体检、心电图、胸部X线和超声心动图等检查结果,选择健康志愿者50例为对照组,其中男20例,女30例;年龄18~55岁,平均(34.5±8.7)岁。
  1.2  检查方法
    受检者取左侧卧位,平稳呼吸,采用GE公司生产的Vivid 7型多功能彩色多普勒超声诊断系统,探头频率1.5~4.3 MHz。于心尖四腔切面测量右心房(RA)横径、右心室(RV)横径、左心房(LA)横径、左心室(LV)横径,用三尖瓣反流压差(△P)估测肺动脉收缩压(PASP,PASP=△P+1.33 kPa)。进入组织速度成像(TVI)模式,将帧频调节至每秒大于100帧,进入SI模式,冻结图像于舒张末期,将取样容积(大小为10 mm)分别置于心尖四腔心切面的右室侧壁三尖瓣环处、右室侧壁中部、室间隔二尖瓣环处、室间隔中部、左室侧壁二尖瓣环处以及左室侧壁中部,得出各室壁心肌节段的应变(S)曲线,记录每一个心动周期收缩期峰值应变(Ss)。获取图像时,声束尽量与心肌运动方向保持一致。所有超声图像存入MO磁盘中,备脱机分析。每个超声指标至少测量3个连续心动周期,取平均值。ASD组分别于术前3 d、术后1周、术后3月进行以上检查。
  1.3  统计学处理
    应用SPSS 11.5统计学软件进行数据处理,计量资料以±s表示,数据间比较采用t检验和F检验。
  2  结 果
  2.1  ASD封堵手术前、后各房室腔大小及PASP比较
    与对照组比较,ASD组RA、 RV、PASP明显增大,差异均有显著意义(t=2.23~2.87,P<0.05);与术前比较,术后1周RA、 RV、 PASP显著减小,术后3个月RA、 RV、PASP进一步减小,差异有显著性(F=7.58~13.46,q=3.50~3.98,P<0.05),余参数差异无统计学意义。见表1。表1  ASD封堵术前后各房室腔大小及PASP比较(略)
  2.2  ASD封堵手术前后应变参数比较
    与对照组比较,ASD组术前右室壁和室间隔、左室侧壁二尖瓣环处Ss显著增大,差异有显著性(t=2.04~2.97,P<0.05)。与封堵术前比较,术后1周右室侧壁三尖瓣环处和右室侧壁中部、室间隔中部Ss较前均显著降低,差异有显著意义(F=8.57~14.66,q=3.67~4.90,P<0.05);室间隔二尖瓣环处和左室侧壁二尖瓣环处、中部Ss较术前略降低,但差异无统计学意义。术后3个月右室侧壁三尖瓣环处和右室侧壁中部、室间隔和左室壁Ss均较术前显著降低(q=3.46~3.86,P<0.05);与封堵术后1周比较,术后3个月右室侧壁中部Ss显著降低(F=9.98~17.59,q=3.46~3.86,P<0.05),余参数差异无统计学意义。见表2。表2  ASD封堵术前后心室各壁峰值应变比较(略)

我爱论文网(www.5alw.com)是国内顶尖的代写毕业论文,硕士论文代写,职称论文发表的服务机构,我们致力于为广大客户提供最优秀的毕业论文代写和职称论文发表服务!
版权声明
    凡本站稿件类型为“原创”的所有文字、图片和音视频等稿件,均为我爱论文网版权所有,未经本站协议授权,任何媒体、网站及个人均不得转载或以其它方式发表,违者必究。如需转载,请注明出处。