经食管超声对风湿性二尖瓣狭窄患者自发显影的研究  

Study of Spontaneous Echo Contrast in Patients with Rheumatic Mitral Stenosis by Transesophageal Echocardiography

作　　者：唐红[1] 黄鹤[1] 张庆[1] 刘淑华[1] 饶莉[1] 刘天虎[2] 

机构地区：[1]华西医科大学附属第一医院心内科,成都610041 [2]郫县人民医院内科

出　　处：《华西医科大学学报》2000年第2期217-219,共3页Journal of West China University of Medical Sciences

摘　　要：为探讨风湿性二尖瓣狭窄（MS）患者自发显影（SEC）与左心耳功能状态、心房纤颤及血栓形成的关系，作者采用经胸及经食管超声测量了117例风湿性二尖瓣狭窄患者的左房径（LAD）、二尖瓣口面积（MVA）、左心耳最大面积（LAA－area）、最大充盈速度（LAA－VPf）和最大排空速度（LAA－VPe），并观察了左心房和左心耳血栓及SEC程度。结果：该117例患者中，窦性心律57例，房颤60例；无血栓者98例，血栓19例；无SEC者46例，SEC71例；与无SEC组比较，SEC组LAA－Vpf明显减低（0．18±0．01m／s：0．31±0．03m／s，P＜0．05）；LAA－Vpe亦明显减低（0．17±0．01m／s：0．32±0．02m／s，P＜0．05）；血栓和房颤出现率明显增高（P＜0．05），LAD增大D（4．39±0．85mm:41．76±1．05mm，P＜0．05），LAA－area增大（8.06±0．32cm2：692±0.31cm2，P＜0．05），MVA减小（1．07±0．33cm2：1．32±0．45cm2，P＜0．05）。上述结果提示，心房纤颤、二尖瓣口面积和左房大小是SEC形成的独立相关因素，SEC与左心耳功能呈显著负相关（F1＝33．2，F＝46．7），SEC与血栓形成有显著相关（OddsRatio＝2．50）。Spontaneous echo contrast (SEC) is common in the areas of slow blood flow. This study was conducted to examine the correlation of SEC and left atrial appendage function, atriaI fibrillation (Af) and thrombus in patients with rheumatic mitral stenosis. The transthoracic and multiplane transesophageal echocardiograms were performed on 117 patients (mean age 42. 22 ±10. 79 years ). Left atrial size, left atrial appendage area, mitral valve area, left atrial appendage flow peak emptic velocity and full velocity were measured.The presence of SEC and thrombus in the left atrium and appendage was noted. The results showed that among the patients, 57 had normal sinus rhythm, 60 had Af; 19 had thrombus, 98 had no thrombus; 71 had SEC and 46 had no SEC. Compared with the patients without SEC, the patients with SEC showed greater incidence of thrombus (28. 76% vs 0,P<0.05), higher rate of Af (69. 01 % vs 23. 91 %, P<0. 05), larger LAD (46. 93±0. 85mm vs 41. 76±1. 05mm, P<0. 05), larger LAA area (8. 06±0. 32cm2 vs 6. 92 ±0. 31cm2, P<0. 05), smaller MVA area (1.07 ±0. 23cm2 vs 1. 32 ± 0. 35cm2, P<0.05), lower LAA flow peak emptic velocity(0. 17 ±0.01m/s vs 0. 32 ± 0. 02m/s, P<0. 05), and lower LAA full velocity (0. 18 ± 0. 01m/s vs 0. 31±0. 03m/s, P<0. 05).These findings indicate that the presence of SEC is associated with significantly greater incidence of thrombus,higher rate of Af, larger LAD and LAA area, smaller MVA area, lower LAA flow peak emptic velocity and full velocity. Atrial fibrillation, the diameter of left atrium and the area of mitral valve are independent predictors of SEC. SEC is significantly associated with LAA function and thrombus formation.

关 键 词：经食管超声 风湿性二尖瓣狭窄 自发显影 

分 类 号：R445.1[医药卫生—影像医学与核医学]