CAJ | 학술논문

　　目的应用双脉冲波多普勒超声成像同步观察健康成年人左心室心肌与相邻心包运动规律及时空相关关系，探讨其临床应用价值。方法应用双脉冲波多普勒超声成像同步采集99名健康成年人3个完整心动周期内二尖瓣水平、乳头肌水平、心尖水平左心室标准短轴切面，测取前壁、后壁共6个节段的同步心肌与相邻心包组织双脉冲频谱多普勒图像。观察不同水平和节段室壁心肌与相邻心包运动规律。在线测量左心室短轴3个水平前壁、后壁心肌与相邻心包在收缩期、舒张早期、舒张晚期的运动峰值速度、速度起始时间及达峰时间，分析节段心肌与相邻心包速度及时间的相关性。结果双脉冲波组织多普勒图像显示，在左心室短轴切面，同一水平同一室壁即同一节段心肌和相邻心包运动方向一致，同一水平前壁（心肌及相邻心包）与后壁（心肌及相邻心包）运动方向相反。峰值速度比较：前壁二尖瓣水平收缩期、舒张晚期，乳头肌水平收缩期心肌峰值速度小于相邻心包峰值速度；后壁二尖瓣水平舒张早期、舒张晚期，乳头肌水平收缩期、舒张早期，心尖水平舒张早期心肌峰值速度大于相邻心包峰值速度，差异均有统计学意义（t＝－4．207、－2．078、4．575、－2．277、－2．440、－2．292、5．980、2．604，P均＜0．05）。起始时间比较：前壁乳头肌水平收缩期、后壁二尖瓣水平舒张早期心肌起始时间小于相邻心包起始时间，差异均有统计学意义（t＝－2．447、－2．020， P均＜0．05）。达峰时间比较：后壁二尖瓣水平收缩期及舒张晚期心肌达峰时间小于相邻心包达峰时间，差异均有统计学意义（t＝－3．530、－2．411，P均＜0．05）。所测各节段心肌与邻近心包的峰值速度、起始时间、达峰时间均具有良好的相关性（r＝0．407～0．933，P均＜0．01）。结论应用组织多普勒超声实时同步双脉冲频谱技术可观察到健康成年人左心室各节段心肌与相邻心包的运动速度显著相关、运动方向一致。有望为临床诊断缩窄性心包炎及其与限制性心肌病相鉴别提供一种新方法。　　目的應用雙脈遲波多普勒超聲成像同步觀察健康成年人左心室心肌與相鄰心包運動規律及時空相關關繫，探討其臨床應用價值。方法應用雙脈遲波多普勒超聲成像同步採集99名健康成年人3箇完整心動週期內二尖瓣水平、乳頭肌水平、心尖水平左心室標準短軸切麵，測取前壁、後壁共6箇節段的同步心肌與相鄰心包組織雙脈遲頻譜多普勒圖像。觀察不同水平和節段室壁心肌與相鄰心包運動規律。在線測量左心室短軸3箇水平前壁、後壁心肌與相鄰心包在收縮期、舒張早期、舒張晚期的運動峰值速度、速度起始時間及達峰時間，分析節段心肌與相鄰心包速度及時間的相關性。結果雙脈遲波組織多普勒圖像顯示，在左心室短軸切麵，同一水平同一室壁即同一節段心肌和相鄰心包運動方嚮一緻，同一水平前壁（心肌及相鄰心包）與後壁（心肌及相鄰心包）運動方嚮相反。峰值速度比較：前壁二尖瓣水平收縮期、舒張晚期，乳頭肌水平收縮期心肌峰值速度小于相鄰心包峰值速度；後壁二尖瓣水平舒張早期、舒張晚期，乳頭肌水平收縮期、舒張早期，心尖水平舒張早期心肌峰值速度大于相鄰心包峰值速度，差異均有統計學意義（t＝－4．207、－2．078、4．575、－2．277、－2．440、－2．292、5．980、2．604，P均＜0．05）。起始時間比較：前壁乳頭肌水平收縮期、後壁二尖瓣水平舒張早期心肌起始時間小于相鄰心包起始時間，差異均有統計學意義（t＝－2．447、－2．020， P均＜0．05）。達峰時間比較：後壁二尖瓣水平收縮期及舒張晚期心肌達峰時間小于相鄰心包達峰時間，差異均有統計學意義（t＝－3．530、－2．411，P均＜0．05）。所測各節段心肌與鄰近心包的峰值速度、起始時間、達峰時間均具有良好的相關性（r＝0．407～0．933，P均＜0．01）。結論應用組織多普勒超聲實時同步雙脈遲頻譜技術可觀察到健康成年人左心室各節段心肌與相鄰心包的運動速度顯著相關、運動方嚮一緻。有望為臨床診斷縮窄性心包炎及其與限製性心肌病相鑒彆提供一種新方法。
　　목적응용쌍맥충파다보륵초성성상동보관찰건강성년인좌심실심기여상린심포운동규률급시공상관관계，탐토기림상응용개치。방법응용쌍맥충파다보륵초성성상동보채집99명건강성년인3개완정심동주기내이첨판수평、유두기수평、심첨수평좌심실표준단축절면，측취전벽、후벽공6개절단적동보심기여상린심포조직쌍맥충빈보다보륵도상。관찰불동수평화절단실벽심기여상린심포운동규률。재선측량좌심실단축3개수평전벽、후벽심기여상린심포재수축기、서장조기、서장만기적운동봉치속도、속도기시시간급체봉시간，분석절단심기여상린심포속도급시간적상관성。결과쌍맥충파조직다보륵도상현시，재좌심실단축절면，동일수평동일실벽즉동일절단심기화상린심포운동방향일치，동일수평전벽（심기급상린심포）여후벽（심기급상린심포）운동방향상반。봉치속도비교：전벽이첨판수평수축기、서장만기，유두기수평수축기심기봉치속도소우상린심포봉치속도；후벽이첨판수평서장조기、서장만기，유두기수평수축기、서장조기，심첨수평서장조기심기봉치속도대우상린심포봉치속도，차이균유통계학의의（t＝－4．207、－2．078、4．575、－2．277、－2．440、－2．292、5．980、2．604，P균＜0．05）。기시시간비교：전벽유두기수평수축기、후벽이첨판수평서장조기심기기시시간소우상린심포기시시간，차이균유통계학의의（t＝－2．447、－2．020， P균＜0．05）。체봉시간비교：후벽이첨판수평수축기급서장만기심기체봉시간소우상린심포체봉시간，차이균유통계학의의（t＝－3．530、－2．411，P균＜0．05）。소측각절단심기여린근심포적봉치속도、기시시간、체봉시간균구유량호적상관성（r＝0．407～0．933，P균＜0．01）。결론응용조직다보륵초성실시동보쌍맥충빈보기술가관찰도건강성년인좌심실각절단심기여상린심포적운동속도현저상관、운동방향일치。유망위림상진단축착성심포염급기여한제성심기병상감별제공일충신방법。
Objective To investigate the clinical value , the motive regularity, the temporal and spatial correlation between myocardium and adjacent pericardium of left ventricular short -axis in normal adsults by using dual pulse wave Doppler echocardiography .Methods Tissue dual pulse spectral Doppler images about segmental myocardium and adjacent pericardial of three complete cardiac cycles in 99 normal adults were collected synchronously by using dual pulse wave Doppler techenology ,6 segments were enrolled in this study, including the anterior and posterior wall at mitral valve , papillary muscles, and apex level of left ventricular short-axis view.The motive regularity of myocardium and adjacent pericardium at different levels and segments were observed .Peak speed, onset time and peak time between myocardium and adjacent pericardium in anterior and posterior wall of three valves were measured online in systolic , early diastolic, and late diastolic, and the correlation between segmental myocardium and adjacent pericardium in speed and time were analyzed.Results Dual pulse wave Doppler echocardiography showed that in left ventricular short-axis view, motion between myocardium and adjacent pericardium in the same segment had consistent direction, motions between myocardium and adjacent pericardium in anterior and posterior wall at the same level had opposite directions .Comparison of peak velocity, in anterior wall, the peak velocities of myocardium in systolic and late diastolic at mitral valve level , and the peak velocity of myocardium in systolic at papillary muscle level were lower than that of adjacent pericardium .In posterior wall, the peak velocities of myocardium in early diastolic and late diastolic at mitral valve level , the peak velocities of myocardium in systolic and early diastolic at papillary muscle level , and the peak velocity of myocardium in early diastolic at apex level were higher than that of adjacent pericardium , with statistical significance (t=-4.207, -2.078, 4.575, -2.277, -2.440, -2.292, 5.980, 2.604, all P<0.05).Comparison of onset time, the onset time of myocardium in systolic at papillary muscle level in anterior wall , and the onset time of myocardium in early diastolic at mitral valve level in posterior wall were lower than that of adjacent pericardium, with statistical significance (t =-2.447, -2.020, both P<0.05).Comparison of peak time, except the peak time of myocardium in systolic and early diastolic at mitral valve level in posterior wall was lower than that of adjacent pericardium , the remaining differences were statistically significant ( t =-3.530, -2.411, both P<0.05).Peak velocity, onset times and peak times of each segment measured between myocardium and adjacent pericardium were well correlated (r =0.407 -0.933, all P <0.01). Conclusions Dual pulse wave Doppler echocardiography can provide relativity and accordance between motive velocity and direction of left ventricular myocardium and adjacent pericardium in normal adults .It is a promising new method for the clinical diagnosis of constrictive pericarditis and differentiation with restrictive cardiomyopathy.