CAJ | 학술논문

目的探讨超声二维应变技术评估不同术式二尖瓣置换前后左心室收缩功能的应用价值.方法 48例行二尖瓣置换术患者,根据是否保留后瓣及瓣下结构分为保留组(A组)和切除组(B组),于手术前后分别采集心尖四腔观、心尖两腔观、心尖左室长轴观图像,应用二维应变软件对各切面追踪分析,得出左室各节段纵向峰值应变(Sp)和整体应变(GS).结果 ①A组术后后间隔和下壁基底段、侧壁中间段Sp增高(P＜0.01或P＜0.05)；B组术后后间隔基底段和中间段Sp明显增高(P＜0.01),而侧壁基底段、中间段和前壁中间段、心尖段Sp减低(P＜0.01或P＜0.05).②B组前壁中间段和心尖段、侧壁和下壁中间段手术前后Sp差值较A组减低(P＜0.01或P＜0.05).③A组术后GS增高(P＜0.05)；B组术后GS有减低趋势(P＞0.05)；B组手术前后GS差值较A组减低(P＜0.05).结论二尖瓣置换时,尽量保留瓣下结构更有利于术后早期左心室局部及整体心肌功能的恢复；超声二维应变技术可较准确地评价二尖瓣置换术后早期左心室局部及整体收缩功能,对于指导临床治疗和评估预后具有一定应用价值.
목적 탐토초성이유응변기술평고불동술식이첨판치환전후좌심실수축공능적응용개치.방법 48례행이첨판치환술환자,근거시부보류후판급판하결구분위보류조(A조)화절제조(B조),우수술전후분별채집심첨사강관、심첨량강관、심첨좌실장축관도상,응용이유응변연건대각절면추종분석,득출좌실각절단종향봉치응변(Sp)화정체응변(GS).결과 ①A조술후후간격화하벽기저단、측벽중간단Sp증고(P＜0.01혹P＜0.05)；B조술후후간격기저단화중간단Sp명현증고(P＜0.01),이측벽기저단、중간단화전벽중간단、심첨단Sp감저(P＜0.01혹P＜0.05).②B조전벽중간단화심첨단、측벽화하벽중간단수술전후Sp차치교A조감저(P＜0.01혹P＜0.05).③A조술후GS증고(P＜0.05)；B조술후GS유감저추세(P＞0.05)；B조수술전후GS차치교A조감저(P＜0.05).결론 이첨판치환시,진량보류판하결구경유리우술후조기좌심실국부급정체심기공능적회복；초성이유응변기술가교준학지평개이첨판치환술후조기좌심실국부급정체수축공능,대우지도림상치료화평고예후구유일정응용개치.
Objective To evaluate regional and global systolic function of left ventricle (LV) after mitral valve replacement(MVR) of different methods by 2-dimensional strain (2DS).Methods According to the operational method whether preserve the posterior leaflet and its subvalvular apparatus,48 patients who underwent MVR were divided into two groups,the preservation group (group A) and the resection group (group B).Echocardiography was examinated before and after MVR and the apical four-chamber view,two-chamber view and long-axis view of LV were acquired.Regional peak strain (Sp) and global strain (GS) of LV longitudinal movement were analysed by 2DS software.Results ①Compared to preoperation,the Sp in basal segment of posterior septum and inferior wall and middle segment of lateral wall in group A increased significantly ( P ＜0.01 or P ＜0.05).The Sp of group B were improved in both basal and middle segments of posterior septum ( P ＜0.05),while declined in middle segment of lateral wall and anterior wall,basal segment of lateral wall and apical segment of anterior wall significantly (P ＜0.01 or P ＜0.05).②Compared with group A,subtractions between preoperative and postoperative Sp of group B decreased in middle segment and apical segment of anterior wall,middle segment of lateral wall and middle segment of inferior wall significantly ( P ＜0.01 or P ＜0.05).③The GS of group A increased significantly ( P ＜0.05),while that in group B tended to reduce with no statistical significance ( P ＞0.05).Compared with group A,subtractions between preoperative and postoperative GS of group B droped significantly (P ＜ 0.05).Conclusions Appropriate preservation of the posterior leaflet and its subvalvular apparatus has morebeneficial effect in improving the early regional and global function of LV after surgery,which would be recommended in MVR.Early regional and global systolic function of LV after MVR could be accurately evaluated by 2DS relatively,which has the application value of guiding clinical treatment and estimating prognosis.