继发孔型房间隔缺损介入治疗前后超声心动图心功能的对比研究  

Echocardiographic research of cardiac function of secundum atrial septal defect before and after interventional therapy

作　　者：肖燕燕[1] 韩玲[1] 金梅[1] 张桂珍[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,北京100029

出　　处：《心肺血管病杂志》2011年第5期385-391,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家"十一五"支撑计划(项目编号:2007BA105B03)

摘　　要：目的:使用组织多普勒技术,对房间隔缺损(atrial septal defect,ASD)介入治疗术前、后的心功能和血流动力学情况,进行对比和随访研究,了解介入治疗及封堵器植入对ASD患者心功能的影响。方法:44例单纯继发孔型ASD患者,24例为封堵术近期组,20例为封堵术中远期组,按照封堵器与左心房面,房间隔面积比的中位值分别将近期组和中远期组,分为大伞组和小伞组。所有患者,进行经胸常规及组织多普勒超声心动图检查。对所获得的组织多普勒(tissue doppler image,TDI)信息,进行图像后处理。观察封堵术前后心室肌和心房肌运动速度,应变和应变率的变化。结果:1.近期大伞组和小伞组,术前右心室游离壁基底段,各时期峰值速度均较相应对照组增高(P<0.05);各组右心房侧壁收缩速度较对照组增高(P<0.05);封堵术后1 d,各组右心室游离壁基底段,各时期峰值速度迅速下降。同期大伞组与小伞组相比较,术前二者间收缩期运动速度差异有统计学意义(P<0.05)。2.近期大伞组和小伞组术前右心室游离壁基底段收缩期、舒张期的峰值,应变及应变率均较对照组增高(P<0.05),右心房侧壁舒张期峰值,应变及应变率较对照组增高(P<0.05)。封堵术后1 d右心室游离壁基底段收缩期、舒张期和右心房侧壁的峰值应变及应变率即显著下降;同期大伞组与小伞组测定值比较,大伞组术前右心室游离壁收缩期和舒张期,应变及应变率较小伞组增高(P<0.05),术后1 d大伞组右心室游离壁舒张期应变率较小伞组增高(P<0.05)。结论:1.本组ASD患者的右心系统处于高动力状态,封堵术使这种高动力状态恢复,封堵术后1 d可见明显恢复,至术后6个月左右,右心功能恢复至正常对照组水平。2.本研究未见左心和右心功能受封堵器大小和植入时间长短的影响,提示ASD封堵术安全有效。3.组织多普勒技术能够更为早期、细致地评价心功能�Objective：Using Tissue Doppler imaging echocardiography to research the cardiac function of atrial septal defect（atrial septal defect,ASD） patients before and after intervention in the short-term and long-term follow-up study.Methods：44 cases of Secundum ASD patients were involved in this research.24 cases were short-term group,20 cases were mid-long term group.According to the area ratio of occluder and the atrial septal of left side,the shot term and the mid-long term cases were devided into big occluder group and small occluder group seperately.Short term group were examined at before therapy,after therapy 1 d,1 m,3 m,6 m and 12 m,mid-long term were examined when follow up.2D,Doppler,TDI data were acquired,analysised and compared between the groups.Results：1 TDI results： in the short term group,the peak velocity of systole,early diastole and late diastole increased at basal segment of RV lateral wall（P0.05）,The systolic velocity of RA lateral wall were also increased（P 0.05）.1 d after occlusion,the peak velocity of systole,early diastole and late diastole increased at basal segment of RV lateral wall decreased significantly.the velocity of systole,diastole of the RV lateral wall were higher in big occluder group than in small occluder group especially before operation.2.Strain and SR result： In the short term group,the peak strain and SR of systole,early diastole and late diastole of basal segment of RV lateral wall increased（P0.05）,the peak strain and SR of diastole of RA lateral wall increased than in control group before operation（P 0.05）.1.d after occlusion,the increasing strain and SR of RV lateral wall and RA lateral wall decreasedsignificantly.Compared with small occluder group,Systole and diastole strain and SR of RV lateral wall were higher in big occluder group（P 0.05）.The diastole SR of RV lateral wall were higher in big occluder group than in small occluder group（P 0.05）.No difference were found of the strain and SR in the mid-long term group than in control gr

关 键 词：房间隔缺损 介入治疗 超声心动描记术 先天性心脏病 应变率 

分 类 号：R541.1[医药卫生—心血管疾病]