二维斑点追踪显像技术评价成人房间隔缺损右心室功能的初步研究  

Assessment of right ventricular function by two dimensional speckle tracking imaging in patients with atrial septal defects

作　　者：楼玉美[1] 谢琳媛[2] 沈文均[1] 徐卫峰[1] 马小欣[1] 郑哲岚[2] 

机构地区：[1]宁波市医疗中心李惠利医院心血管内科,浙江宁波315000 [2]浙江大学医学院附属第一医院超声影像科

出　　处：《上海医学》2013年第8期716-720,F0002,共6页Shanghai Medical Journal

摘　　要：目的本研究通过二维斑点追踪显像技术(2D-STI)对房间隔缺损未行矫正术的成人患者右心室游离壁各节段进行测量,获得应变和应变率等相关数据,分析右心室的局部功能。方法选择35例继发孔型房间隔缺损的成人患者入房间隔缺损组,以20名超声心动图检查显示心脏无结构性和功能性改变、窦性心律、未服用任何药物的成人作为对照组。分别在心尖四腔切面取得连续5个心动周期的动态图像,存盘后用脱机软件QLab中的TMQA功能测得右心室游离壁各节段的纵向应变和应变率数据(结合心电图,以及计算得到最大应变和应变率、平均收缩期应变和应变率、平均舒张期应变和应变率)。结果房间隔缺损组右心室游离壁中间段、心尖段的最大应变和平均收缩期应变均显著高于对照组相同节段(P值均<0.05);右心室游离壁基底段的平均舒张期应变显著低于对照组相同节段(P<0.05),中间段、心尖段的舒张期应变均显著高于对照组相同节段(P值均<0.05)。组右心室游离壁基底段、中间段、心尖段的最大应变率和平均收缩期应变率均显著高于对照组相同节段(P值均<0.05),右心室游离壁中间段、心尖段的平均舒张期应变率均显著高于对照组相同节段(P值均<0.05)。房间隔缺损组室间隔心尖段的平均舒张期应变显著高于对照组相同节段(P<0.05)。结论未行矫正术的房间隔缺损成人患者右心室游离壁应变、应变率与正常成人有显著差异,提示右心系统容量负荷增加对右心局部功能产生显著影响。2D-STI是一种无创评价右心室局部功能的有效手段。Objective To measure the strain and strain rate of free wall of the right ventricle by two dimensional speckle tracking imaging （2D-STI） in patients with uncorrected atrial septal defect （ASD） and to assess right ventricular regional function. Methods Thirty-five patients with ASD （ASD group） and 20 healthy adults （control group, no structural and functional changes in heart and sinus rhythm by echocardiography, no administration of any drug） were enrolled in this study. Live images of 5 consecutive heart cycles were acquired in apical four-chamber view. Strain and strain rate were analyzed by QLab Software. Maximum strain and strain rate, mean systolic strain and strain rate, and mean diastolic strain and strain rate were calculated. Results Maximum strain, mean systolic strain and mean diastolic strain in the middle and apical segments of right ventricular free wall in the ASD group were significantly higher than those in the control group （all P^0.05）. Mean diastolic strain in basal lateral wall in the ASD group was significantly lower than that in the control group （P^0.05）. Maximum strain rate and mean systolic strain rate in the basal, middle and apical segments of right ventricular free wall in the ASD group were significantly higher than those in the control group （all P〈0.05）. Mean diastolic strain rate in the middle and apical segments in the ASD group was significantly higher than that in the control group （both P〈 0.05）. Conclusion Strain and strain rate in adults with uncorrected ASD are significantly different from healthy adults, which indicates that the increase of volume load in the right ventricle affects right ventricular regional function. 2D-STI is an effective non-invasive method to assess right ventricular regional function. （Shanghai Med J, 2013, 36： 716-720）

关 键 词：超声心电描记术 房间隔缺损 应变 应变显像 右心室功能 二维斑点追踪显像技术 

分 类 号：R541.1[医药卫生—心血管疾病]