CAJ | 학술논문

目的应用二维斑点追踪(two-dimensional speckle tracking imaging,2D-STI)技术及实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价急性肺栓塞(acute pulmonaryembolism,APE)患者右室收缩功能的临床应用价值.方法确诊的APE患者80例,依据早期病死率进行危险分层,将患者分为低危组(30例)、中危组(26例)和高危组(24例).正常对照组60例.应用2D-STI技术测量右室整体、右室游离壁及室间隔基底段、中间段和心尖段的纵向收缩期峰值应变(￡)值;应用RT-3DE测量右室舒张末期容积(RVEDV)、收缩末期容积(RVESV)、每搏输出量(RVSV)、射血分数(RVEF)和峰值排空率(PER).分析常规超声测值与2D-STI技术和RT-3DE测值之间的相关性.结果 ①APE患者较对照组右室整体、右室游离壁及室间隔各节段ε值减低,且随着危险程度增加其逐渐减低,其中以右室游离壁基底段和中间段减低最显著,差异有统计学意义(P＜0.05).②与对照组比较,中危组及高危组RVEDV、RVESV增高,RVEF、PER减低,低危组无明显变化,且随危险程度增加,RVEDV、RVESV逐渐增高,RVEF、PER逐渐减低,差异有统计学意义(P＜0.05).③APE组肺动脉收缩压(PASP)、三尖瓣环收缩期位移(TAPSE)与右室整体、右室游离壁各节段￡值及RVEF、PER之间有良好相关性,差异有统计学意义(P＜0.01).结论 APE患者右心功能受到了不同程度的损害,2D-STI技术及RT-3DE可以客观、准确、敏感地评价右室收缩功能的变化,有助于早期诊断及评价疗效.
목적 응용이유반점추종(two-dimensional speckle tracking imaging,2D-STI)기술급실시삼유초성심동도(real-time three-dimensional echocardiography,RT-3DE)평개급성폐전새(acute pulmonaryembolism,APE)환자우실수축공능적림상응용개치.방법 학진적APE환자80례,의거조기병사솔진행위험분층,장환자분위저위조(30례)、중위조(26례)화고위조(24례).정상대조조60례.응용2D-STI기술측량우실정체、우실유리벽급실간격기저단、중간단화심첨단적종향수축기봉치응변(￡)치;응용RT-3DE측량우실서장말기용적(RVEDV)、수축말기용적(RVESV)、매박수출량(RVSV)、사혈분수(RVEF)화봉치배공솔(PER).분석상규초성측치여2D-STI기술화RT-3DE측치지간적상관성.결과 ①APE환자교대조조우실정체、우실유리벽급실간격각절단ε치감저,차수착위험정도증가기축점감저,기중이우실유리벽기저단화중간단감저최현저,차이유통계학의의(P＜0.05).②여대조조비교,중위조급고위조RVEDV、RVESV증고,RVEF、PER감저,저위조무명현변화,차수위험정도증가,RVEDV、RVESV축점증고,RVEF、PER축점감저,차이유통계학의의(P＜0.05).③APE조폐동맥수축압(PASP)、삼첨판배수축기위이(TAPSE)여우실정체、우실유리벽각절단￡치급RVEF、PER지간유량호상관성,차이유통계학의의(P＜0.01).결론 APE환자우심공능수도료불동정도적손해,2D-STI기술급RT-3DE가이객관、준학、민감지평개우실수축공능적변화,유조우조기진단급평개료효.
Objective To investigate the right ventricular systolic function in patients with acute pulmonary embolism(APE) by two-dimensional speckle tracking imaging(2D-STI) and real-time three dimensional echocardiography(RT-3DE).Methods A total of 80 patients with APE were divided into 3 subgroups(the low risk group:including 30 patients;the moderate risk group:including 26 patients;the high risk group:including 24 patients) according to the expected pulmonary embolism-related early mortality.Sixty healthy subjects were served as controls.The longitudinal peak systolic strain (ε) values of RV global,septal and free wall for basal,mid and apical segments were measured by 2D-STI.The right ventricular end-diastolic volume (RVEDV),right ventricular end-systolic volume (RVESV),right ventricular stroke volume (RVSV),right ventricular ejection fraction (RVEF) and peak ejection rate (PER) were measured by RT-3DE.The correlations of measure values between the conventional ultrasound and 2D-STI or RT-3DE measurements in patients with APE were analyzed.Results ①In patients with APE,the ε of RV global,septal and free wall for basal,mid and apical segments were lower than those in the control group,and with the increase in the degree of risk,the ε of RV were gradually decreased,and ε of basal and mid segments of RV free wall were significantly reduced (P ＜0.05).②Compared with the control group,RVEDV,RVESV were increased and PER,RVEF were reduced in the high and moderate risk groups,while there were no significant alteration in low risk group.And with the increase in the degree of risk,RVEDV,RVESV were gradually increased and PER,RVEF were gradually reduced (P ＜0.05).(③)In patients with APE,PASP and TAPSE correlated well with RVEF,PER and the ε of RV global,all free wall segments.Conclusions Right ventricular systolic function in patients with APE was decreased to various levels.RT-3DE and 2D-STI can evaluate the changes of right ventricular function accurately in patients with APE,which are helpful to early diagnosis and evaluation of curative effect.