全方向M型超声心动图监测在二尖瓣置换术后即刻左室心肌功能评估中的应用  

Application of omni-directional M-mode echocardiography monitoring in evaluation of left ventricular myocardial function immediately after mitral valve replacement

作　　者：俞秋红 赵奕文 

机构地区：[1]上海奉贤区中心医院超声医学科,上海201400

出　　处：《中国临床研究》2017年第7期980-983,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨应用全方向M型超声心动图(OME)在二尖瓣置换术(MVR)手术开始前及术后即刻进行监测,对其左室心肌功能评估的价值。方法选取2015年1月至2016年10月二尖瓣狭窄并关闭不全实施MVR的患者61例,根据心电图结果分为Ⅰ组(窦性心律)24例及Ⅱ组(房颤心律)37例。采用OME于MVR手术开始前和手术结束拔升主动脉插管前全灌注时测量患者室间隔、左室侧壁、前壁、下壁各位点收缩期最大位移、峰值速度及达峰时间变化情况,以为手术者和麻醉师提供对患者左室心肌功能实时评估的依据。结果 (1)收缩期最大位移:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期最大位移均大于术前,差异有统计学意义(P<0.01,P<0.05);(2)收缩期峰值速度:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期峰值速度均高于术前,差异有统计学意义(P均<0.05);(3)收缩期达峰时间:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期达峰时间均小于术前,差异有统计学意义(P<0.01,P<0.05)。结论应用OME系统实时监测,可为MVR术后即刻了解患者左心室各节段室壁运动的信息、评估其术后左室心肌功能提供参考。Objective To explore the value of omni-directional M-mode echocardiography（OME） monitoring for assessing left ventricular myocardial functions before and immediately after mitral valve replacement （MVR）. Methods Sixty-one patients with mitral stenosis and insufficiency underwent MVR between January 2015 and October 2016 were selected. The patients were divided into group Ⅰ （ sinus rhythm, n = 24 ） and group Ⅱ （ atrial fibrillation rhythm, n = 37 ） according to ECG findings. OME system was used to measure the maximum displacement, peak velocity and time to peak velocity in the systole at sites of interventricular septum,left ventricular lateral wall, anterior wall and inferior wall before operation and during the total infusion before extubation of ascending aortic eannulation at the end of the operation to provide the basis for real-time assessment of left ventricular myocardial function for the surgeon and anesthesiologist. Results The systolic maximum displacements immediately after operation at each sites in group Ⅱ and at sites of interventricular septum and left ventricular anterior wall in group Ⅰ were significantly more than those before operation （P 〈 0.01 ,P 〈 0.05 ）. The systolic peak velocities immediately after operation at each sites in group Ⅱ and at sites of interventricular septum and left ventrieular anterior wall in group Ⅰ were significantly higher than those before operation（ all P 〈 0.05 ）. The times to peak velocity in the systole immediately after operation at each sites in group Ⅱ and at sites of interventricular septum and left ventrieular anterior wall in group Ⅰ were significantly lower than those before operation（ P 〈 0. 01 ,P 〈 0.05 ）. Conclusion Real time monitoring with OME system can provide a basis for the acquaintance of the instant motion information of different segments of left ventricular wall and assessment of left ventricular myocardial functions immediately after MVR.

关 键 词：全方向M型超声心动图 监测 二尖瓣置换术 收缩期最大位移 峰值速度 达峰时间 左室心肌功能 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]