二尖瓣狭窄下游湍流强度体内多普勒超声定量研究  

A Quantitative Study of Turbulent Intensity Downstream of Mitral Stenosis with Doppler Echocardiography in Vivo

作　　者：张桂敏[1] 石应康[2] 唐红[3] 张尔永[2] 郭仲三[4] 樊渝波[5] 蒲放[5] 

机构地区：[1]山东医科大学附属第一医院心外科,济南250012 [2]华西医科大学附属第一医院胸心外科,成都610041 [3]华西医科大学附属第一医院彩超室,成都610041 [4]中科院成都计算所,成都610042 [5]四川大学生物力学系,成都610043

出　　处：《现代临床医学生物工程学杂志》2001年第5期321-324,共4页Journal of Modern Clinical Medical Bioengineering

基　　金：国家自然科学基金资助项目 批准号 :39770 2 0 5

摘　　要：目的　以无创的多普勒超声检测方法了解二尖瓣狭窄下游血流不同部位湍流强度特点 ,探讨湍流剪应力(turbulentshearstress,TSS)、相对扰动强度 (relativeturbulentintensity ,Irel)与狭窄病变间的相互关系 ,为深入研究瓣膜疾病发生发展机制与人工心瓣血流动力学提供前期基础和科学依据 .方法　应用与计算机图像分析技术相结合的多普勒超声 ,对一组不同程度二尖瓣狭窄病人二尖瓣下游跨瓣血流不同部位湍流强度进行定量描述 .结果　二尖瓣狭窄下游射流区TSS与Irel均明显低于射流周围湍流区 .射流区TSS与Irel在不同狭窄程度组间差异均无显著性 (p >0 .0 5 ) ,而湍流区TSS与Irel在不同狭窄程度组间差异均存在显著性 (p<0 .0 5 ) ,并且 ,TSS和Irel均与有效瓣口面积 (effectiveori ficearea,EOA)成明显负相关 (r各为 - 0 .84和 - 0 .82 ) .超声显示 ,绝大部分患者瓣尖部位病变的严重程度远高于瓣膜的其它部分 .结论　二尖瓣狭窄下游射流周围湍流区湍流强度远高于射流区 ,狭窄病变越重 ,湍流强度越大 ,而射流区湍流强度与狭窄程度无关 .TSS集中分布于湍流区与瓣膜病变的空间对应关系提示 ,TSS是导致瓣膜病变进行性加重不容忽视的重要因素 ,其具体作用机制有待进一步研究加以阐明 .此外 ,生物心瓣Objective We hpoe to understand the characteristic of turbulent intensity in the different locations downstream of mitral stenosis with the non-invasive Doppler echocardiography. And we will make the correlation between turbulent shear stress (TSS), relative turbulent intensity (I rel ) and stenotic lesion clear in order to provide us with the basis and scientific foundation for our further study on the mechanism of origination and development of valvular diseases and the hemodynamics of artificial heart valve.Methods We used Doppler echocardiography combined with the imaging analysis of compute to evaluate quantitatively turbulent intensity in different locations downstream of mitral valve in a group of patients with the varying-degree mitral stenosis. Results TSS and I rel in the region of jet downstream of mitral stenosis are lower than those in the region of turbulence around jet. There is no significant difference for TSS and I rel in the region of jet between the groups of varying-degree mitral stenosis(p>0.05).But there is significant difference for TSS and I rel in the region of turbulence between the same ones(p<0.05). Both TSS and I rel correlated with effective orifice area(r were-0.84～-0.88 and -0.82～-0.86 respectively). The data of echocardiography showed that in most of patients the extent of lesion in the portion of leaflet tip was more than that in the portions of leaflet middle and base. Conclusions The turbulent intensity in the region of turbulence around jet downstream of mitral stenosis is higher than that in the region of jet. The more severe the stenosis is, the bigger the turbulent intensity is. But the turbulent intensity in the region of jet does not correlate with the extent of stenosis(r were -0.19～0.15 and -0.20～0.18 respectively). The correlation that TSS focusing in the region of turbulence corresponds in space with valvular lesion indicates that TSS is an important cause that results in the progressing aggravation of valvular lesion. This mechanis

关 键 词：二尖瓣狭窄 湍流强度 多普勒超声 定量分析 

分 类 号：R445.1[医药卫生—影像医学与核医学]