经皮动脉导管未闭封堵术后左、右心室Tei指数的变化及其与心室重构的相关性  

Changes of Tei-index and its relevance with ventricular remolding after transcatheter closure of patent ductus arteriosus

作　　者：郭治彬[1] 付金国[1] 刘睦胜[1] 马延峰[1] 

机构地区：[1]南昌大学第一附属医院心内科,江西南昌330006

出　　处：《临床荟萃》2007年第21期1532-1536,共5页Clinical Focus

基　　金：江西省卫生厅科技计划资助课题(No.20061050)

摘　　要：目的观察经皮动脉导管未闭(PDA)介入封堵术后心脏结构和心功能Tei指数的变化及其影响因素,探讨Tei指数与心房、心室重构的相关性及其临床意义。方法研究对象为我院施行PDA经导管封堵后的患者16例,并选择年龄相当的16例健康人作为对照组,应用超声心动图测定左、右心室Tei指数、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)和主动脉瓣血流速度峰值(Vp)等指标,并将PDA封堵术前后患者的左心室Tei指数的变化与LVEDD、LVEF、Vp等指标的变化作相关性分析。结果①PDA封堵成功率100%,封堵成功的患者均于术前、术后2天及3个月行经胸超声心动图检查和随访,均无残余分流和并发症,生活质量良好;②PDA患者术前左心室Tei指数较正常组显著升高(P<0.01),术后2天左心室Tei指数较术前显著升高(P<0.01),术后3个月左心室Tei指数恢复到正常范围内,PDA患者封堵术前后右心室Tei指数变化差异无统计学意义(P>0.05);③PDA封堵前LAD、LVEDD、LVESD、LVFS、LVEF、Vp均较正常对照组明显增大(P<0.05),术后2天均明显减小(P<0.05),术后3个月恢复到正常范围内,PDA封堵后右室舒张末期前后径(RVEDD)未见明显改变(P>0.05);④PDA封堵术后Tei指数的变化与LVEDD、LVEF及Vp的变化均呈显著的负相关(r分别为-0.528、-0.504、-0.515,均P<0.05),Tei指数与相应的R-R间期的变化无显著相关性。结论①介入封堵治疗后PDA患者Tei指数短期内均显著升高,于术后3个月恢复正常;②短期内Tei指数的变化与LVEDD、LVEF、Vp的变化呈负相关,Tei指数可以作为反映心功能变化的可靠的指标;③介入封堵治疗PDA患者通过纠正心脏的异常通道,可使心脏功能恢复正常。Objective To observe the changes of myocardial performance index （Tei index） in patients with patent ductus arteriosus（PDA） treated by transcatherter closure, and identify its associated factors and its relevance with ventricular remolding. Methods Sixteen patients with PDA underwent transcatheter closure using occluder, Tei index of left and right ventricules,left ventricular（LV） end diastolic dimension （LVEDD）, LV ejection fraction （LVEF） and others were measured with echocardiograph before and after transcatheter closure at two days and three months respectively. Results The transcatheter closure success rate of PDA was 100% in the hospital. Echocardiography showed that the trace shunt had completely disappeared after transcatheter closure with occluder. Tel index of LV before the transcatheter closure was significantly higher than that of normals （ P 〈 0.01）. After the transcatheter closure two days,Tel index of LV got even much higher than before transcatheter closure. Meanwhile their LVEDD, LVEF decreased significantly after the transcatheter closure two days （ P 〈 0.01）. The change of Tel index after closure of PDA correlated well with LVEF and LVEDD. The change of Tei index of LV inversely correlated with the changes of LVEF and LVEDD at two days. Tel index recovered to normal after transcatheter closure three months. Conclusion ① After the patients with PDA treated by transcatheter closure,Tel index of LV once reached a higher level but returned to normal soon. It suggests that the transcatheter closure of ocluder method is safe and efficient. ② After transcatheter closure of PDA,Tei index of LV increased significantly and its change negatively correlated with the decrease of LV preload.③ Tel index is an effective index to predict the heart function and efficiency after transeatheter closure of oeeluder.

关 键 词：动脉导管未闭 心室重构 超声心动描记术 

分 类 号：R541.13[医药卫生—心血管疾病]