组织多普勒应变率成像技术评价不同二尖瓣置换术式左心室局部心肌功能变化  

Chocardiographic assessent of regional left ventricular function after mitral valve replacement with and without chordal preservation by strain rate imaging

作　　者：郭勇[1] 何怡华[1] 李治安[1] 张纯[1] 张烨[1] 谷孝艳[1] 韩建成[1] 陈倬[1] 

机构地区：[1]首都医科大学附属北京安贞医院超声诊断科,100029

出　　处：《中华医学超声杂志（电子版）》2013年第8期628-632,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金资助项目(30970840)

摘　　要：目的利用组织多普勒应变率成像技术评价不同二尖瓣置换术式患者手术前后左心室局部心肌功能变化情况。方法 55例行二尖瓣置换的患者根据手术方式不同分为切除全部瓣下结构组(全切组,20例)、保留后叶瓣下结构组(20例)和保留全部瓣下结构组(15例)。分别于术前1周、术后7～10d及术后3个月采用组织多普勒应变率成像技术测量患者左心室中间段不同节段(后间隔、侧壁、前壁、下壁、前间隔、后壁)心肌应变率,对比分析3组患者手术前后左心室中间段局部心肌应变率变化情况。结果术前1周,全切组、保留后叶瓣下结构组和保留全部瓣下结构组患者左心室中间段不同节段(后间隔、侧壁、前壁、下壁、前间隔、后壁)心肌应变率比较差异均无统计学意义(F=0.37、0.74、0.90,P均>0.05)。术后7～10d,3组患者左心室中间段大部分节段心肌应变率较术前1周显著降低,3组患者左心室中间段不同节段心肌应变率比较差异有统计学意义(F=3.91、8.12、7.57,P均=0.00)。术后3个月,保留后叶瓣下结构组患者左心室后间隔、侧壁、前壁、前间隔心肌应变率均较术前1周显著增高,且差异均有统计学意义(t=2.12、3.19、3.25、2.08,P均<0.05);保留全部瓣下结构组患者左心室后间隔、侧壁、前壁、前间隔、后壁心肌应变率均较术前1周显著增高,且差异亦均有统计学意义(t=2.78、4.79、2.81、2.58、2.87,P均<0.05);全切组患者左心室中间段不同节段心肌应变率与术前1周比较差异均无统计学意义(t=1.60、0.34、1.04、0.73、0.70、1.68,P均>0.05);全切组、保留后叶瓣下结构组患者左心室中间段不同节段心肌应变率差异比较均有统计学意义(F=17.8、8.52,P均<0.05),而保留全部瓣下结构组患者左心室中间段不同节段心肌应变率比较差异无统计学意义(F=1.76,P>0.05)。结论不同二尖瓣置换术式手术前后左心室局部心肌功能变�Objective To investigate the regional left ventricular function after mitral valve replacement with and without chordal preservation by strain rate imaging. Methods A total of 55 patients undergoing mitral valve replacement were enrolled. Twenty underwent complete excision of the subvalvular apparatus (group A), 20 preserved the posterior chordopapillary apparatus only (group B) and the other 15 underwent total chordal preservation (group C). Systolic peak strain rate (SRs) were measured preoperatively, at 7-10 days and 3 months after operation. Results Before operation, SRs had no differences between&nbsp;different segments of the left ventricular in each group (F=0.37, 0.74, 0.90, all P>0.05). At 7-10 days after operation, SRs in the most segments of left ventricular were signiifcantly lower than those of before operation (F=3.91, 8.12, 7.57, all P<0.05). At 3 months after operation, SRs in some segments of left ventricular were signiifcantly higher than those of preoperation in each group (t=2.12, 3.19, 3.25, 2.08, 2.78, 4.79, 2.81, 2.58, 2.87, 1.60, 0.34, 1.04, 0.73, 0.70, 1.68, all P<0.05). SRs had no signiifcant differences between each segment of left ventricular in group C (F=1.76, P>0.05). By contrast, SRs in some segments of left ventricular were different from those of other segments in group A and group B (F=17.8, 8.52, both P<0.05). Conclusion Comparing to conventional mitral valve replacement and mitral valve replacement with preservation of posterior subvalvular apparatus, mitral valve replacement with preservation of total subvalvular apparatus makes the papiltary function preserved completely, which are beneifcial for the motor coordination of left ventricular wall and the recovery of regional left ventricular function.

关 键 词：超声心动描记术 多普勒 心脏瓣膜假体植入 心室功能 左 

分 类 号：R654.2[医药卫生—外科学]