中华超声影像学杂志
中華超聲影像學雜誌
중화초성영상학잡지
CHINESE JOURNAL OF ULTRASONOGRAPHY
2012年
11期
932-936
,共5页
孙艳丹%石晶%张军%刘丽文%左蕾%拓胜军%沈敏%马斌%徐辉%朱霆%鲁晶%师增增
孫豔丹%石晶%張軍%劉麗文%左蕾%拓勝軍%瀋敏%馬斌%徐輝%硃霆%魯晶%師增增
손염단%석정%장군%류려문%좌뢰%탁성군%침민%마빈%서휘%주정%로정%사증증
超声心动描记术%心力衰竭,充血性%心室功能,左%心室重构%心脏再同步化治疗
超聲心動描記術%心力衰竭,充血性%心室功能,左%心室重構%心髒再同步化治療
초성심동묘기술%심력쇠갈,충혈성%심실공능,좌%심실중구%심장재동보화치료
Echocardiography%Heart failure,congestive%Ventricular function,left%Ventricular remodeling%Cardiac resynchronization therapy
目的 观察短暂中断心脏再同步化治疗(CRT)后慢性心力衰竭(CHF)患者左室血流动力学变化,探讨逆重构与非逆重构患者CRT期间血流动力学获益情况.方法 连续选择行CRT术后6月以上的随访患者46例,根据左室收缩末容积减小≥15％分为逆重构组和非逆重构组.分别在CRT开放和关闭两种模式下对两组患者行超声心动图检查,测量二尖瓣反流面积(MRA)、主动脉瓣上血流速度时间积分(VTI-AV)、二尖瓣舒张期流速时间积分(VTI-MV)、左心室压力最大上升速率(+dp/dtmax),左室充盈时间占心动周期比例(LVFT/T),分别比较两组患者中断CRT前后上述血流动力学指标的变化,计算两组患者中断CRT前后上述指标的变化率ΔMRA、ΔVTI-AV、ΔVTI-MV、Δdp/dt和ΔLVFT/T,比较两组患者中断CRT前后上述指标的变化差异.结果 两组患者中断CRT10 min后MRA均有不同程度的增加(P均＜0.01),VTI-AV、VTI-MV以及+dp/dtmax均有不同程度减低(P均＜0.05),LVFT/T均有不同程度减小(P均＜0.05),逆重构组ΔMRA、ΔVTI-MV、Δdp/dt均明显高于非逆重构组(P＜0.05),而两组ΔVTI-AV和ΔLVFT/T相比差异无统计学意义(P＞0.05).结论 对于中长期CRT患者,无论左室是否发生逆重构,中断CRT 10 min后左室血流动力学参数均显著恶化,且逆重构组恶化较非逆重构组明显,提示CRT期间逆重构患者和非逆重构患者均持续获得CRT的血流动力学益处,逆重构组较非逆重构组获益大.
目的 觀察短暫中斷心髒再同步化治療(CRT)後慢性心力衰竭(CHF)患者左室血流動力學變化,探討逆重構與非逆重構患者CRT期間血流動力學穫益情況.方法 連續選擇行CRT術後6月以上的隨訪患者46例,根據左室收縮末容積減小≥15％分為逆重構組和非逆重構組.分彆在CRT開放和關閉兩種模式下對兩組患者行超聲心動圖檢查,測量二尖瓣反流麵積(MRA)、主動脈瓣上血流速度時間積分(VTI-AV)、二尖瓣舒張期流速時間積分(VTI-MV)、左心室壓力最大上升速率(+dp/dtmax),左室充盈時間佔心動週期比例(LVFT/T),分彆比較兩組患者中斷CRT前後上述血流動力學指標的變化,計算兩組患者中斷CRT前後上述指標的變化率ΔMRA、ΔVTI-AV、ΔVTI-MV、Δdp/dt和ΔLVFT/T,比較兩組患者中斷CRT前後上述指標的變化差異.結果 兩組患者中斷CRT10 min後MRA均有不同程度的增加(P均＜0.01),VTI-AV、VTI-MV以及+dp/dtmax均有不同程度減低(P均＜0.05),LVFT/T均有不同程度減小(P均＜0.05),逆重構組ΔMRA、ΔVTI-MV、Δdp/dt均明顯高于非逆重構組(P＜0.05),而兩組ΔVTI-AV和ΔLVFT/T相比差異無統計學意義(P＞0.05).結論 對于中長期CRT患者,無論左室是否髮生逆重構,中斷CRT 10 min後左室血流動力學參數均顯著噁化,且逆重構組噁化較非逆重構組明顯,提示CRT期間逆重構患者和非逆重構患者均持續穫得CRT的血流動力學益處,逆重構組較非逆重構組穫益大.
목적 관찰단잠중단심장재동보화치료(CRT)후만성심력쇠갈(CHF)환자좌실혈류동역학변화,탐토역중구여비역중구환자CRT기간혈류동역학획익정황.방법 련속선택행CRT술후6월이상적수방환자46례,근거좌실수축말용적감소≥15％분위역중구조화비역중구조.분별재CRT개방화관폐량충모식하대량조환자행초성심동도검사,측량이첨판반류면적(MRA)、주동맥판상혈류속도시간적분(VTI-AV)、이첨판서장기류속시간적분(VTI-MV)、좌심실압력최대상승속솔(+dp/dtmax),좌실충영시간점심동주기비례(LVFT/T),분별비교량조환자중단CRT전후상술혈류동역학지표적변화,계산량조환자중단CRT전후상술지표적변화솔ΔMRA、ΔVTI-AV、ΔVTI-MV、Δdp/dt화ΔLVFT/T,비교량조환자중단CRT전후상술지표적변화차이.결과 량조환자중단CRT10 min후MRA균유불동정도적증가(P균＜0.01),VTI-AV、VTI-MV이급+dp/dtmax균유불동정도감저(P균＜0.05),LVFT/T균유불동정도감소(P균＜0.05),역중구조ΔMRA、ΔVTI-MV、Δdp/dt균명현고우비역중구조(P＜0.05),이량조ΔVTI-AV화ΔLVFT/T상비차이무통계학의의(P＞0.05).결론 대우중장기CRT환자,무론좌실시부발생역중구,중단CRT 10 min후좌실혈류동역학삼수균현저악화,차역중구조악화교비역중구조명현,제시CRT기간역중구환자화비역중구환자균지속획득CRT적혈류동역학익처,역중구조교비역중구조획익대.
Objective To observe the hemodynamic changes of acute after cardiac resynchronization therapy(CRT) interruption in patients with chronic heart failure (CHF),and explore the benefit of hemodynamic of the reverse remodeling and non-reverse remodeling CHF patients during CRT.Methods 46 CHF patients who had undergone implantation of CRT device for more than 6 months were enrolled in the study.The reverse remodeling and non-reverse remodeling were identified by reduction of LV end-systolic volumes ≥ 15％.The two groups underwent echocardiography,and mitral regurgitation area (MRA),velocity time integral of aortic valve (VTI-AV),velocity time integral of mitral valve(VTI-MV),maximum rising rate of left intra-ventricular pressure(+ dp/dtmax),LVFT/T were measured in "on" and "off" mode of CRT.Hemodynamic indicators of two groups were compared in CRT on and off modes.The rate of changes of above mentioned parameters ΔMRA,ΔVTI-AV,ΔVTI-MV,Δdp/dt and ΔLVFT/T were calculated and compared in the two groups.Results MRA had significant increasing in both group after 10 minutes intereuption of CRT (P ＜0.01).Two groups had significant worsening of VTI-AV,VTI-AV,+ dp/dtmax and LVFT/T after 10 minutes interruption of CRT as compared to CRT-on mode (P ＜0.05).ΔMRA,ΔVTI-MV,Δdp/dt of reverse remodeling group significantly higher than non-reverse remodeling group(P ＜0.05).But there was no difference in ΔVTI-AV and ΔLVFT/T(P ＞0.05).Conclusions The hemodynamic index become worsening after 10 minutes interruption of CRT in both group of medium-and long-term CRT patients especially in reverse remodeling group,suggesting that patients of both groups have obtained hemodynamic benefits continuously during CRT.Reverse remodeling group get more benefits than non reverse remodeling group.
