中华超声影像学杂志
中華超聲影像學雜誌
중화초성영상학잡지
CHINESE JOURNAL OF ULTRASONOGRAPHY
2014年
8期
651-655
,共5页
张秉宜%郭瑞强%周青%石明%周立明%宋宏宁%谭团团
張秉宜%郭瑞彊%週青%石明%週立明%宋宏寧%譚糰糰
장병의%곽서강%주청%석명%주립명%송굉저%담단단
超声心动描记术%尿毒症%肾透析%心室功能,左%三维斑点追踪显像
超聲心動描記術%尿毒癥%腎透析%心室功能,左%三維斑點追蹤顯像
초성심동묘기술%뇨독증%신투석%심실공능,좌%삼유반점추종현상
Echocardiography%Uremia%Renal dialysis%Ventricular function,left%Three-dimensional speckle tracking imaging
目的 应用三维超声斑点追踪成像(3-dimensional speckle tracking imaging,3D-STI)技术评价单次透析对尿毒症患者左室整体收缩功能的影响.方法 选取门诊维持血液透析稳定的尿毒症患者37例,于透析前、后30 min内各行一次心脏超声检查.选取29例年龄、性别匹配的健康志愿者为正常对照组.测量超声常规指标并计算左室心肌质量指数(LVMI),并用组织多普勒显像(TDI)测量二尖瓣环收缩期峰值速度(S ').3D-STI测量指标:取标准心尖四腔观采集左室全容积图像并存储,应用3D-STI软件进行脱机分析,自动计算出左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)以及左室整体纵向收缩期峰值应变(LVGLS)、径向收缩期峰值应变(LVGRS)、圆周收缩期峰值应变(LVGCS)和面积收缩期峰值应变(LVGAS).比较透析前与正常对照组,透析前、后超声常规指标及3D-STI指标结果的差异.结果 ①常规超声结果:与对照组比较,尿毒症透析前左室舒张末期内径(LVDD)、室间隔舒张末期厚度(IVSD)、左室后壁舒张末期厚度(LVWPD)、左房内径(LAD)测值均显著增大,差异有统计学意义(P＜0.05),而S'则降低(均P＜0.05).与对照组比较,尿毒症透析前LVMI明显高于正常对照组(P＜0.05).透析后LVDD、LAD、左房容积指数(LAV index)测值均较透析前显著降低(均P＜0.05),而S '在透析前后无显著变化(P＞0.05).②3D-STI结果:与对照组比较,尿毒症透析前LVEF、LVGLS、LVGCS、LVGRS、LVGAS测值均显著降低(均P＜0.05);LVEDV、LVESV较对照组显著升高(均P＜0.05);透析后LVEDV、LVESV、LVGLS较透析前测值均显著降低(均P＜0.05),而LVEF、LVGRS、LVGCS、LVGAS较透析前无显著变化(均P＞0.05).结论 单次血透前、后左室整体收缩功能无显著改变,但LVGLS在透析后短期显著降低,表明该参数对前负荷的变化较敏感,呈容量负荷依赖性.故在测量尿毒症患者的LVGLS时要充分考虑到患者的前负荷状态.
目的 應用三維超聲斑點追蹤成像(3-dimensional speckle tracking imaging,3D-STI)技術評價單次透析對尿毒癥患者左室整體收縮功能的影響.方法 選取門診維持血液透析穩定的尿毒癥患者37例,于透析前、後30 min內各行一次心髒超聲檢查.選取29例年齡、性彆匹配的健康誌願者為正常對照組.測量超聲常規指標併計算左室心肌質量指數(LVMI),併用組織多普勒顯像(TDI)測量二尖瓣環收縮期峰值速度(S ').3D-STI測量指標:取標準心尖四腔觀採集左室全容積圖像併存儲,應用3D-STI軟件進行脫機分析,自動計算齣左室舒張末期容積(LVEDV)、左室收縮末期容積(LVESV)、左室射血分數(LVEF)以及左室整體縱嚮收縮期峰值應變(LVGLS)、徑嚮收縮期峰值應變(LVGRS)、圓週收縮期峰值應變(LVGCS)和麵積收縮期峰值應變(LVGAS).比較透析前與正常對照組,透析前、後超聲常規指標及3D-STI指標結果的差異.結果 ①常規超聲結果:與對照組比較,尿毒癥透析前左室舒張末期內徑(LVDD)、室間隔舒張末期厚度(IVSD)、左室後壁舒張末期厚度(LVWPD)、左房內徑(LAD)測值均顯著增大,差異有統計學意義(P＜0.05),而S'則降低(均P＜0.05).與對照組比較,尿毒癥透析前LVMI明顯高于正常對照組(P＜0.05).透析後LVDD、LAD、左房容積指數(LAV index)測值均較透析前顯著降低(均P＜0.05),而S '在透析前後無顯著變化(P＞0.05).②3D-STI結果:與對照組比較,尿毒癥透析前LVEF、LVGLS、LVGCS、LVGRS、LVGAS測值均顯著降低(均P＜0.05);LVEDV、LVESV較對照組顯著升高(均P＜0.05);透析後LVEDV、LVESV、LVGLS較透析前測值均顯著降低(均P＜0.05),而LVEF、LVGRS、LVGCS、LVGAS較透析前無顯著變化(均P＞0.05).結論 單次血透前、後左室整體收縮功能無顯著改變,但LVGLS在透析後短期顯著降低,錶明該參數對前負荷的變化較敏感,呈容量負荷依賴性.故在測量尿毒癥患者的LVGLS時要充分攷慮到患者的前負荷狀態.
목적 응용삼유초성반점추종성상(3-dimensional speckle tracking imaging,3D-STI)기술평개단차투석대뇨독증환자좌실정체수축공능적영향.방법 선취문진유지혈액투석은정적뇨독증환자37례,우투석전、후30 min내각행일차심장초성검사.선취29례년령、성별필배적건강지원자위정상대조조.측량초성상규지표병계산좌실심기질량지수(LVMI),병용조직다보륵현상(TDI)측량이첨판배수축기봉치속도(S ').3D-STI측량지표:취표준심첨사강관채집좌실전용적도상병존저,응용3D-STI연건진행탈궤분석,자동계산출좌실서장말기용적(LVEDV)、좌실수축말기용적(LVESV)、좌실사혈분수(LVEF)이급좌실정체종향수축기봉치응변(LVGLS)、경향수축기봉치응변(LVGRS)、원주수축기봉치응변(LVGCS)화면적수축기봉치응변(LVGAS).비교투석전여정상대조조,투석전、후초성상규지표급3D-STI지표결과적차이.결과 ①상규초성결과:여대조조비교,뇨독증투석전좌실서장말기내경(LVDD)、실간격서장말기후도(IVSD)、좌실후벽서장말기후도(LVWPD)、좌방내경(LAD)측치균현저증대,차이유통계학의의(P＜0.05),이S'칙강저(균P＜0.05).여대조조비교,뇨독증투석전LVMI명현고우정상대조조(P＜0.05).투석후LVDD、LAD、좌방용적지수(LAV index)측치균교투석전현저강저(균P＜0.05),이S '재투석전후무현저변화(P＞0.05).②3D-STI결과:여대조조비교,뇨독증투석전LVEF、LVGLS、LVGCS、LVGRS、LVGAS측치균현저강저(균P＜0.05);LVEDV、LVESV교대조조현저승고(균P＜0.05);투석후LVEDV、LVESV、LVGLS교투석전측치균현저강저(균P＜0.05),이LVEF、LVGRS、LVGCS、LVGAS교투석전무현저변화(균P＞0.05).결론 단차혈투전、후좌실정체수축공능무현저개변,단LVGLS재투석후단기현저강저,표명해삼수대전부하적변화교민감,정용량부하의뢰성.고재측량뇨독증환자적LVGLS시요충분고필도환자적전부하상태.
Objective To assess the impact of a single hemodialysis on the left ventricular systolic function of uremia patients with 3-dimensional ultrasound speckle tracking imaging (3D-STI).Methods Thirty-seven clinically stable outpatients with uremia undergoing hemodialysis were studied.The echocardiographic examinations were obtained in 30 minutes before and after homodialysis.Twenty nine normal subjects with age and sex matched were selected as control groups.Conventional ultrasound was recorded and then left ventricular mass index(LVMI) was calculated.The peak systolic mitral annular velocity S' was recorded by tissue Doppler imaging.3D-STI imaging were recorded from standard left ventricular apical 4-chamber views before and after a single hemodialysis.Left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF),and left ventricular global longitudinal peak systolic strain (LVGLS),left ventricular global radial peak systolic strain (LVGRS),left ventricular global circumferential peak systolic strain (LVGCS),left ventricular global area peak systolic strain (LVGAS) were measured.The indicators of conventional ultrasound and 3D-STI were compared between the pre-hemodialysis group and the normal control group,and also between pre-and post-hemodialysis groups.Results ①Compared with the control group,the left ventricular end-diastolic diameter (LVDD),interventrieular septal thickness at diastole (IVSD),left ventricular posterior wall thickness at diastole(LVWPD),left atrial diameter(LAD) in the group before a single hemodialysis were significantly higher (P ＜0.05 for all).Meanwhile,the S' was significantly lower (P ＞0.05) and LVMI was significantly higher in the pre-hemodialysis group than the control group(P ＜ 0.05).The LVDD,LAD,left atrial volume index(LAVI) were significantly lower in the post-hemodialysis group than that in the pre-hemodialysis group(P ＜0.05 for all).②Results of 3D-STI showed that the LVEF,LVGLS,LVGCS,LVGRS,LVGAS was significantly lower,however LVEDV,LVESV were higher in the pre-hemodialysis group compared with the control group (P ＜ 0.05 for all).After a single hemodialysis,LVEDV,LVESV,LVGLS were significantly lower than before(P ＜0.05 for all),but LVEF,LVGRS,LVGCS,LVGAS were not significantly changed (P ＞ 0.05 for all).Conclusions After a single hemodialysis,the whole systolic function of the left ventricular was not changed.but the left ventricular global longitudinal peak systolic strain was significantly lower.The parameter of LVGLS was sensitive to the change of preload and was volume-load dependent.The preload of the patients should be sufficiently considered when the LVGLS are measured in the patients with uremia undergoing hemodialysis.
