原位心脏移植术后早期超声心动图改变  

Early change of echocardiography after orthotopic heart transplantation

作　　者：刘少中[1] 刘晓真[1] 叶木奇[1] 

机构地区：[1]广东中山市人民医院超声影像科,528400

出　　处：《器官移植》2015年第1期46-50,共5页Organ Transplantation

摘　　要：目的：探讨应用超声心动图在原位心脏移植术后的早期应用价值。方法应用超声心动图对29例原位心脏移植术后患者进行早期监测，于术后1、7、14、30 d 记录左心室舒张末径（LVDd）、右心室舒张末径（RVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）和三尖瓣反流面积，并计算左心室射血分数（LVEF）、左心室Tei指数（LV-Tei）。同时记录患者血压、中心静脉压（CVP）。结果与术后1 d比较，术后7、14、30 d的LVDd均较大，RVDd均较小（均为P＜0.05）。与术后7 d比较，术后1、14、30 d的IVST、LVPWT数值均较低（均为P＜0.05）。与术后7 d比较，术后1、14、30 d的血压、CVP、LV-Tei数值均较低，差异有统计学意义（均为P＜0.05）；各时间点LVEF比较差异无统计学意义（均为P＞0.05）。超声心动图检查于术后3～4 d发现三尖瓣反流，三尖瓣反流面积于术后5～8 d达最大面积（9.2＆#177;2.5）cm2，此后反流面积逐渐减少，术后1个月时减少至（4.7＆#177;2.4） cm2。结论在原位心脏移植术后早期，应用超声心动图可有效监测移植心脏的结构及功能情况，及时为临床医师提供多种参数作为诊疗的依据。Objective To investigate the early application value of echocardiography （UCG）after orthotopic heart transplantation （OHT）. Methods A total of 29 patients were monitored by UCG early after OHT. On the 1st,7th,14th,30th day after operation,the left ventricular end-diastolic diameter （LVDd）and right ventricular end-diastolic diameter （RVDd）,interventricular septal thickness （IVST）,left ventricular posterior wall thickness （LVPWT）and the tricuspid regurgitation area （TRA）were measured,and the left ventricular ejection fraction （LVEF ） and left ventricle Tei index （LV-Tei ） were calculated. The blood pressures （BP）,central venous pressure （CVP）of the patients were recorded simultaneously. Results The LVDd were larger on the 7th,14th and 30th day after operation,while the RVDd were smaller,compared with those on the 1st day after operation （all in P〈0.05）. The IVST,LVPWT were lower on the 1th,14th and 30th day after operation,compared with those on the 7th day after operation （all in P〈0.05）. The BP,CVP,LV-Tei were all significantly lower on the 1st,14th and 30th day after operation,compared with those on the 7th day after operation （P〈0.05 ）. There was no significant difference in LVEF between each time points（P〉0.05 ）.The tricuspid regurgitation was detected in 3-4 d after operation by UCG,and the TRA reached the peak value [（9.2 ＆#177;2.5）cm2]in 5-8 d after operation,then gradually decreased to （4.7 ＆#177;2.4）cm2 at 1 month after operation. Conclusions Early phase after OHT,the structure and function of transplanted heart can be monitored effectively by echocardiography,and it can timely provide multiple parameters as the basis of diagnosis and treatment for clinical doctors.

关 键 词：超声心动描记术 原位心脏移植 左心室Tei指数 三尖瓣反流 心包积液 

分 类 号：R617[医药卫生—外科学] R445[医药卫生—临床医学]