组织多普勒超声评价病窦综合征患者起搏器置入前后左右心房的同步性  

Evaluation of left and right atrial synchrony in patients with sick sinus syndrome before and after pacemaker implantation by tissue Doppler ultrasonography

作　　者：封雪[1] 卢岷 张茂惠[1] 任建丽[1] 冉海涛[1] 王志刚[1] 

机构地区：[1]重庆医科大学超声影像研究所,400010 [2]重庆市中医院超声科

出　　处：《中华超声影像学杂志》2017年第12期1013-1017,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目（81471713）;2015重庆市卫生计生委医学科研项目（2015MSXM024）

摘　　要：应用组织多普勒成像（TDI）评价病窦综合征（SSS）患者置入起搏器前后心房内及心房间的同步性。 方法选取SSS患者38例，于起搏器置入前后行超声心动图检查；25例健康志愿者作为对照组。超声测量左右心房径线。于心尖四腔切面将TDI取样容积分别置于三尖瓣环右心房侧、房间隔侧及二尖瓣环左心房侧。测量舒张早期波（E波）及舒张晚期波（A波）的间隔时间（E-AR、E-AI、E-AL）、A波持续时间（AR、AI、AL）；同时测量其电机械偶联时间，即同步心电图P波起点至A波起点时间（P-A0R、P-A0I、P-A0L），P波起点至A波峰值时间（P-AR、P-AI、P-AL）；并计算右心房内电机械延迟时间：P-A0I与P-A0R差值（T0IR）、P-AI与P-AR差值（TIR）；左心房内电机械延迟时间：P-A0L与P-A0I差值（T0LI）、P-AL与P-AI差值（TLI）；左右心房间电机械延迟时间：P-A0L与P-A0R差值（T0LR）、P-AL与P-AR差值（TLR）。 结果与对照组比较，SSS组术前左心房前后径和左右径、右心房左右径和上下径增大，E-AR、E-AI、E-AL，P-A0R、P-A0I、P-AR、P-AL延长，而T0LI、T0LR缩短（均P〈0.05）。与术前比较，SSS组术后E-AR、E-AI、E-AL缩短，T0LI、T0LR延长（均P〈0.05）；而与对照组比较，SSS组术后左右心房径线仍增大，P-A0I、P-AR、P-AL仍延长（均P〈0.05）。对照组及SSS组术后组内AR、AI、AL依次缩短（均P〈0.05）。 结论SSS患者心房内及心房间电机械活动存在不同步，置入起搏器治疗有助于改善部分心房的电机械活动同步性。To evaluate the intra- and interatrial synchronization before and after pacemaker implantation in patients with sick sinus syndrome （SSS） by tissue Doppler imaging （TDI）.MethodsThirty-eight patients with SSS （SSS group） underwent pacemaker implantation.Echocardiography was performed before and after operation. Twenty-five volunteers were chosen as control group. Routine measurement of left and right atrial diameter by echocardiography. In apical four chamber view, the sample volume of TDI was located at right atrial lateral wall at tricuspid annulus, interatrial septum and left atrial lateral wall at mitral annulus. The interval time between the early diastolic wave （E wave） and the late diastolic wave （A wave） （E-AR, E-AI, E-AL）, and the duration of A wave （AR, AI, AL） were measured. At the same time, the electromechanical coupling time was measured, namely the initiation of the P wave of the synchronous electrocardiogram to the starting point of A wave （P-A0R, P-A0I, P-A0L）, and the starting point of the P wave to the peak point of the A wave （P-AR, P-AI, P-AL）. And the right atrial electromechanical delay time, P-A0I and P-A0R value （T0IR）, P-AI value and P-AR value （TIR） were recorded.Other parameters include left atrial electromechanical delay time： P-A0L and P-A0I value （T0LI）, and P-AL and P-AI value （TLI）; interatrial electromechanical delay time： P-A0L and P-A0R value （T0LR）, P-AL and P-AR （TLR） were recorded.ResultsCompared with the control group, left atrium and right atrium in SSS group enlarged before operation, E-AR, E-AI, E-AL, P-A0R, P-A0I, P-AR, P-AL prolonged, while T0LR and T0LI were shortened （all P〈0.05）. Postoperative changes in SSS group patients included shortened E-AR, E-AI and E-AL, and prolonged T0LI and T0LR （all P〈0.05）. Compared with the control group, the size of left atriums and right atriums in SSS group still increased postoperation, and the P-A0I、P-AR and P-AL remained longer （all P〈0.05）. The sa

关 键 词：超声心动描记术 病窦综合征 心房功能 心脏起搏 人工 

分 类 号：R445.1[医药卫生—影像医学与核医学]