超声心动图对动脉导管未闭封堵术前后左心室功能的初步研究
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摘要
目的:应用实时三维超声心动图( Real-time three-dimensional echocardiography,RT-3DE )及组织多普勒成像技术( Tissue Doppler imaging,TDI)探讨动脉导管未闭(Patent ductus arteriosus,PDA)封堵术前后容量负荷改变对左心室舒缩功能的影响,评价不同方法测算心功能指标的准确性。
方法:2009年5月至2010年10月,在广西医科大学第一附属医院心血管研究所成功行封堵器堵闭术治疗的PDA患者36例,于术前及术后3天内、1个月、3个月、6个月经胸壁超声心动图(Transthoracic echocardiography,TTE)测算左心室心肌质量指数(Myocardium of left ventricle index,LVMI)、Tei指数、左心室舒张末期容积指数(Left ventricular end-diastolic volume index,LVEDVI)、左心室射血分数(Left ventricle ejection fraction,LVEF);选取年龄与PDA组相匹配的志愿者36例作为正常组,测算与PDA组相对应的心功能指标。
结果:1、PDA组术前左心室Tei指数小于正常组,LVMI及LVEDVI大于正常组,差别均有统计学意义(均P<0.05)。
2、PDA组术后左心室Tei指数大于术前,LVMI及LVEDVI小于术前,差别均有统计学意义(均P<0.05)。左心室Tei指数及LVEDVI(RT-3DE测算值)术后各时点间差别有统计学意义(P<0.05);LVMI(RT-3DE测算值)术后各时点间差别无统计学意义(P>0.05)。LVEF手术前后各时点间差别无统计学意义(P>0.05)。
3、LVMI(RT-3DE测算值)与LVEDVI(RT-3DE测算值)呈正相关趋势,Pearson相关系数r=0.529(P<0.01);左心室Tei指数与LVEDVI(RT-3DE测算值)呈负相关趋势,Pearson相关系数r=-0.161(P<0.05)。
4、LVMI、LVEDVI及LVEF的M型超声心动图( M-mode echocardiography,ME)测算值与RT-3DE测算值比较,差别均有统计学意义(均P<0.05)。
结论:PDA封堵器堵闭术后左心室容量负荷降低。左心室容量负荷的改变对LVMI及Tei指数均产生影响。RT-3ED测算LVMI及TDI测算Tei指数均能准确地反映左心室功能,对PDA封堵术后疗效的判定有重要的临床指导作用。
Objective The aim of this study was to observe the changes of left ventricular function in patients of PDA pre-operation and post-operation treated by transcatheter closure using occluder by RT-3DE and TDI,and to evaluate whether left ventricular function was influenced by the change of blood volume.In addition,the accuracy of different methods in evaluating the left ventricular function were estimated.
Methods LVMI,Tei index,LVEDVI and LVEF were evaluated in 36 patients with PDA who were successfully treated by transcatheter closure using occluder before and after the intervention. Additionally,LVMI,Tei index,LVEDVI and LVEF were evaluated in 36 health volunteers.
Results 1、Before operation,Tei index of patients with PDA were less than the health volunteers,LVMI and LVEDVI were more than the health volunteers,and the differences were statistically significant(P<0.05). 2、After intervention,Tei index of patients with PDA were more than before,LVMI and LVEDVI were less than before,and the differences were statistically significant (P<0.05). Tei index and LVEDVI measured by RT-3DE were significant different at different time (within 3 days,the first month,the third month and the sixth month) after the closure (P<0.05). The change of LVMI obtained by RT-3DE is not dramatically different at different time (within 3 days,the first month,the third month and the sixth month) after the closure (P>0.05). The change of LVEF obtained by RT-3DE before and after intervention is not significant at different time after the intervention (P>0.05). 3、LVMI of patients with PDA evaluated by RT-3DE had a close correlation with LVEDVI evaluated by RT-3DE(r=0.529,P<0.01);Tei index of patients with PDA had a close correlation with LVEDVI evaluated by RT-3DE(r=-0.161,P<0.05).4、LVMI、LVEDVI and LVEF evaluated by ME are statistically different with them evaluated by RT-3DE (P<0.05).
Conclusion After intervention,blood volume of left ventricular decreased. LVMI and Tei index could be influenced by the change of left ventricular blood volume. LVMI estimated by RT-3DE and Tei index estimated by TDI were both able to accurately reflect left ventricular function. They played a significant part in estimating therapeutic effect in patients with PDA after transcatheter closure.
方法:2009年5月至2010年10月,在广西医科大学第一附属医院心血管研究所成功行封堵器堵闭术治疗的PDA患者36例,于术前及术后3天内、1个月、3个月、6个月经胸壁超声心动图(Transthoracic echocardiography,TTE)测算左心室心肌质量指数(Myocardium of left ventricle index,LVMI)、Tei指数、左心室舒张末期容积指数(Left ventricular end-diastolic volume index,LVEDVI)、左心室射血分数(Left ventricle ejection fraction,LVEF);选取年龄与PDA组相匹配的志愿者36例作为正常组,测算与PDA组相对应的心功能指标。
结果:1、PDA组术前左心室Tei指数小于正常组,LVMI及LVEDVI大于正常组,差别均有统计学意义(均P<0.05)。
2、PDA组术后左心室Tei指数大于术前,LVMI及LVEDVI小于术前,差别均有统计学意义(均P<0.05)。左心室Tei指数及LVEDVI(RT-3DE测算值)术后各时点间差别有统计学意义(P<0.05);LVMI(RT-3DE测算值)术后各时点间差别无统计学意义(P>0.05)。LVEF手术前后各时点间差别无统计学意义(P>0.05)。
3、LVMI(RT-3DE测算值)与LVEDVI(RT-3DE测算值)呈正相关趋势,Pearson相关系数r=0.529(P<0.01);左心室Tei指数与LVEDVI(RT-3DE测算值)呈负相关趋势,Pearson相关系数r=-0.161(P<0.05)。
4、LVMI、LVEDVI及LVEF的M型超声心动图( M-mode echocardiography,ME)测算值与RT-3DE测算值比较,差别均有统计学意义(均P<0.05)。
结论:PDA封堵器堵闭术后左心室容量负荷降低。左心室容量负荷的改变对LVMI及Tei指数均产生影响。RT-3ED测算LVMI及TDI测算Tei指数均能准确地反映左心室功能,对PDA封堵术后疗效的判定有重要的临床指导作用。
Objective The aim of this study was to observe the changes of left ventricular function in patients of PDA pre-operation and post-operation treated by transcatheter closure using occluder by RT-3DE and TDI,and to evaluate whether left ventricular function was influenced by the change of blood volume.In addition,the accuracy of different methods in evaluating the left ventricular function were estimated.
Methods LVMI,Tei index,LVEDVI and LVEF were evaluated in 36 patients with PDA who were successfully treated by transcatheter closure using occluder before and after the intervention. Additionally,LVMI,Tei index,LVEDVI and LVEF were evaluated in 36 health volunteers.
Results 1、Before operation,Tei index of patients with PDA were less than the health volunteers,LVMI and LVEDVI were more than the health volunteers,and the differences were statistically significant(P<0.05). 2、After intervention,Tei index of patients with PDA were more than before,LVMI and LVEDVI were less than before,and the differences were statistically significant (P<0.05). Tei index and LVEDVI measured by RT-3DE were significant different at different time (within 3 days,the first month,the third month and the sixth month) after the closure (P<0.05). The change of LVMI obtained by RT-3DE is not dramatically different at different time (within 3 days,the first month,the third month and the sixth month) after the closure (P>0.05). The change of LVEF obtained by RT-3DE before and after intervention is not significant at different time after the intervention (P>0.05). 3、LVMI of patients with PDA evaluated by RT-3DE had a close correlation with LVEDVI evaluated by RT-3DE(r=0.529,P<0.01);Tei index of patients with PDA had a close correlation with LVEDVI evaluated by RT-3DE(r=-0.161,P<0.05).4、LVMI、LVEDVI and LVEF evaluated by ME are statistically different with them evaluated by RT-3DE (P<0.05).
Conclusion After intervention,blood volume of left ventricular decreased. LVMI and Tei index could be influenced by the change of left ventricular blood volume. LVMI estimated by RT-3DE and Tei index estimated by TDI were both able to accurately reflect left ventricular function. They played a significant part in estimating therapeutic effect in patients with PDA after transcatheter closure.
引文
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