二维及实时三维超声心动图对不同病因心衰患者CRT治疗前后心功能评价  

Two-Dimensional and Real-Time Three-Dimensional Echocardiography Assessment of Effect and Valuation of Cardiac Resynchronization Therapy for Treating Heart Failure

作　　者：谢丹[1] 周微微[2] 李晶晶[1] 赵蕊[1] 袁伟[3] 吴宁[1] 田芳[1] 

机构地区：[1]辽宁医学院,辽宁锦州121000 [2]沈阳军区总医院特诊科,辽宁沈阳110016 [3]大连医科大学,辽宁大连116023

出　　处：《创伤与急危重病医学》2014年第4期200-203,254,共5页Trauma and Critical Care Medicine

基　　金：辽宁省科技攻关基金课题(2011225021)

摘　　要：目的应用二维及实时三维超声心动图观察心脏再同步化治疗(CRT)心衰患者的疗效。方法选择2008年3月-2013年8月接受CRT治疗的心衰患者98例,其中扩张性心肌病60例、高血压性心脏病15例、冠心病23例;正常对照组为健康者50例。观察左室射血分数(LVEF),左室舒张末内径(LVEDD),二尖瓣返流面积与左房面积之比(MJA/LAA),主动脉速度时间积分(VTI)和12个节段收缩达峰时间标准差(12Ts-SD)。结果各组患者术前与正常对照组比较整体心功能明显减低;术后半年各组患者整体心功能参数均较术前有明显改善,高血压性心脏病组的LVEDD改善最为明显;术后一年扩张性心肌病较其他两组整体心功能参数有明显改善,但与术后半年无明显差异;术后一年半高血压性心脏病组的MJA/LAA较其他两组改善明显;术后两年高血压性心脏病组的LVEDD和MJA/LAA较其他两组改善明显,各组患者术后12Ts-SD较术前明显改善。结论 CRT可以有效地改善心衰患者的心功能及心脏同步性。在CRT疗效中,高血压性心脏病优于扩张性心肌病和冠心病所致的心力衰竭。Purpose To observe the effect of cardiac resynchronization therapy（CRT） for treating heart failure with the application of two- dimensional and real- time three- dimensional echocardiography. Methods 98 patients were divided into 3 groups,including dilated cardiomyopathy（DCM）group（60 cases）,hypertensive heart disease（HHD） group（15 cases） and coronary heart disease（CHD） group（23 cases）. 50 healthy subjects were enrolled as control group. Left ventricular ejection fraction（LVEF）,left ventricular end- diastolic diameter（LVEDD）,the ratio of mitral regurgitation area and left arterial area（MJA /LAA） and active velocity time integral（VTI） and 12Ts- SD were obtained before and after operation half a year,one year and two years. Result Before operation,global heart function of all patients groups were significantly lower than control group;after operation half one year,heart function of all patients groups were better than before operation. LVEF of group HHD was better than group DCM and CHD; after operation one year,global heart function of group DCM significantly raised than group HHD and group CHD,but there was no evident difference from half one year; after two years,MJR /LAA of group HHD significantly better than group DCM and CHD. The 12 Ts- SD of all patients groups was improved. Conclusions CRT could improve the heart function with heart failure and cardiac synchronization. The effect of CRT for treating heart failure was leaded by hypertensive heart disease are more obvious than heart failure was leaded by dilated cardiomyopaghy or coronary heart disease.

关 键 词：超声心动图 心力衰竭 心脏再同步治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学]