斑点追踪成像与实时三维超声评价肺源性心脏病患者右心室收缩功能  

Evaluation of right ventricular systolic function in patients with pulmonary heart disease by speckle tracking imaging and real-time three-dimensional echocardiograph

作　　者：周赵良[1] 朱文军[1] 庄延兵[1] 吕晓东[1] 金惠红[1] 全丽娟[1] 

机构地区：[1]浙江省嘉兴市第一医院超声科,314001

出　　处：《中华医学超声杂志（电子版）》2013年第6期449-454,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：嘉兴市科技局科技研究计划(2010AY1025)

摘　　要：目的探讨二维斑点追踪技术测定的三尖瓣环位移(TAD)评价肺源性心脏病(简称肺心病)患者右心室收缩功能的价值。方法选取肺心病心功能代偿期(代偿组)、心功能失代偿期(失代偿组)患者各15例,选取同期健康体检者30名作为健康对照组,测量三尖瓣环中点位移(TADmid)、三尖瓣环游离壁位移(TADfre)、三尖瓣环室间隔处位移(TADsep),同时行实时三维超声心动图检测RVEF,并分析TADmid与RVEF、肺动脉收缩压(PASP)之间的相关性。结果健康对照组、代偿组、失代偿组受检者TADmid分别为(17.1±3.9)mm、(13.6±2.6)mm、(9.5±3.2)mm;TADfre分别为(21.1±3.0)mm、(17.6±4.2)mm、(11.5±3.8)mm;TADsep分别为(12.0±2.5)mm、(9.7±3.3)mm、(7.4±2.7)mm;RVEF值分别为(56.3±8.2)%、(39.6±6.4)%、(28.1±5.9)%;PASP值分别为(20.6±2.6)mm Hg(1 mm Hg=0.133 kPa)、(63.3±5.6)mm Hg、(82.5±11.2)mm Hg,3组间比较差异均有统计学意义(F=8.581、7.816、9.300、6.507、10.235,P均<0.05)。代偿组与健康对照组相比:TADfre、TADmid、TADsep均减小,其中以TADmid幅度最大,TADfre幅度最小;RVEF亦明显减低,而PASP增高(t=2.703、2.536、2.379、2.817、3.026,P均<0.05)。失代偿组与对照组相比:TADfre、TADmid、TADsep进一步减小,RVEF明显减低,PASP明显增高(t=2.519、2.493、2.236、2.621、2.985,P均<0.05)。失代偿组与代偿组相比:TADfre、TADmid的减低较明显,TADsep减低幅度较小,RVEF减低,PASP增高(t=1.947、2.680、2.016、2.653、2.893,P均<0.05)。TADmid与实时三维超声心动图测定的RVEF呈显著正相关(r=0.904,P<0.01),与PASP呈显著负相关(r=-0.686,P<0.01)。TADmid评价RVEF<45%及RVEF<30%的截断点值分别为13.65 mm、9.80 mm,敏感度分别为94.4%、90.0%,特异度分别为78.6%、90.0%。结论 TADmid受外部因素影响较小,能较好地反映肺心病患者右心室收缩功能的变化,与实时三维超声心动图测得的RVEF值显著相关,与PASP之间有良好的负相关性,三者结合应用,可以相�Objective To explore the diagnostic value of two-dimensional speckle tracking technology in the evaluation of right ventricular systolic function in patients with pulmonary disease .Methods Thirty patients with pulmonary heart disease were divided into two groups:group of compensated pulmonary heart disease(compensated group ) (n =15),group of decompensated pulmonary heart disease (decompensated group)( n =15).30 healthy subjects were enrolled in control group .The displacement of the tricuspid annulus at the midpoint(TADmid),the displacement of the tricuspid annulus at the free wall (TADfre) and the displacement of the tricuspid annulus at the septum (TADsep) were acquired,and simultaneous real-time three-dimensional ultrasound detection of right ventricular ejection fraction (RVEF) were taken.The correlation of TADmid with RVEF and pulmonary artery systolic pressure ( PASP) were analyzed.Results TADmid of the healthy control group,the compensated group and the decompensated group were(17.1 ±3.9)mm,&nbsp;(13.6 ±2.6)mm,and(9.5 ±3.2)mm respectively.TADfre were(21.1 ±3.0)mm,(17.6 ±4.2)mm,and (11.5 ±3.8) mm respectively.TADsep were(12.0 ±2.5) mm,(9.7 ±3.3) mm,and(7.4 ±2.7) mm respectively.RVEF were(56.3 ±8.2)%,(39.6 ±6.4)%,and(28.1 ±5.9)% respectively.PASP were (20.6 ±2.6) mm Hg (1 mm Hg =0.133 kPa), (63.3 ±5.6) mm Hg, and (82.5 ±11.2)mm Hg respectively.There were significant differences of TADmid , RVEF, and PASP among the 3 groups ( F =8.581,7.816,9.300,6.507,10.235, all P <0.05).TADfre, TADmid, TADsep and RVEF were all decreased in the compensated group comparing to the healthy control group ,while PASP was increased.The decrease of TADmid was the most significant ,while that of TADfre was the slightest .There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups(t=2.703,2.536,2.379, 2.817,3.026,all P<0.05).TADfre,TADmid,TADsep and RVEF of decompensated group reduced more significantly than the compensated group , while PASP was increased significantly .There were

关 键 词：超声心动描记术 三尖瓣 心室功能 右 肺心病 

分 类 号：R541.5[医药卫生—心血管疾病] R445.1[医药卫生—内科学]