实时三维超声心动图评价终末期肾功能衰竭患者血液透析前后左、右心室功能的临床研究  

Real-time three-dimensional echocardiography in reviewing left and right ventricular function in patients with end-stage renal failure before and after hemodialysis:a clinical study

作　　者：薛晓轩[1] 杨玲[1] 陈辉[2] 刘艳[1] 王朝歆[1] 李文华[1] 王超[1] 苑舒淇 Xue Xiaoxuan;Yang Ling;Chen Hui;Liu Yan;Wang Zhaoxin;Li Wenhua;Wang Chao;Yuan Shuqi(Department of Function Test,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China;不详)

机构地区：[1]北京中医药大学东方医院功能检查科,北京100078 [2]首都医科大学附属北京安贞医院心内六科,北京100029

出　　处：《中国循证心血管医学杂志》2020年第8期1006-1009,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨分析实时三维超声心动图评价终末期肾功能衰竭(肾衰)患者血液透析(血透)前后左、右心室功能的临床效果。方法选择2017年10月至2019年10月于北京中医药大学东方医院接受血透治疗的58例患者为血透组,另选取同期60例健康体检者为对照组,血透组患者透析前、透析3个月后以及对照组均进行实时三维超声心动图检查,测定左、右心室功能的相关参数指标,包括左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室每搏输出量(LVSV)、左室整体射血分数(LVEF)、左室局部射血分数(REF)、左室局部-整体射血分数(RGEF)、右室收缩末期容积(RVESV)、右室舒张末期容积(RVEDV)、右室每搏输出量(RVSV)、右室射血分数(RVEF)、右室局部射血分数(rRVEF)。结果血透组患者透析前的LVESV、LVEDV、RVESV、RVEDV检测值显著大于对照组(P<0.05),且LVSV、RVSV、LVEF、REF、RGEF、RVEF明显低于对照组(P<0.05)。血透组血透3个月后,血透组LVESV、LVEDV、LVSV、RVESV、RVEDV均较透析前有改善(P<0.05),但RVEF、RRVEF较透析前显著减少(P<0.05)。经Spearman相关性分析发现,心血管不良事件发生与REF、rRVEF呈显著的正相关性(P<0.05)。结论血透治疗能够改善终末期肾衰患者的左心室功能,但其可对右心室收缩功能造成一定不良影响。实施三维超声心动图具有操作简单、快速、检查准确等优点,能够早期诊断终末期肾衰患者的整体心功能情况,并可具体定量评价到心室局部节段上,可预测心血管不良事件发生,为临床干预提供及时、准确的指导意见。Objective To investigate the clinical effect of real-time three-dimensional echocardiography(RT-3DE)in reviewing left and right ventricular function in patients with end-stage renal failure(ESRF)before and after hemodialysis.Methods The patients(n=58)received hemodialysis were chosen into hemodialysis group and meanwhile healthy control(n=60)were chosen into control group from Dongfang Hospital of Beijing University of Chinese Medicine from Oct.2017 to Oct.2019.The hemodialysis group and control group were given RT-3DE examination before and 3 months after hemodialysis.The parameter indexes related to left and right ventricular functions were detected including left ventricular end-systolic volume(LVESV),left ventricular enddiastolic volume(LVEDV),left ventricular stroke volume(LVSV)and left ventricular global ejection fraction(GEF),left ventricular regional ejection fraction(REF),left ventricular regional-global ejection fraction(RGEF),right ventricular end-systolic volume(RVESV),right ventricular end-diastolic volume(RVEDV),right ventricular stroke volume(RVSV),right ventricular ejection fraction(RVEF)and right ventricular regional ejection fraction(rRVEF).Results The detection values of LVESV,LVEDV,RVESV and RVEDV were significantly higher(P<0.05),and LVSV,RVSV,LVEF,REF,RGEF of RVEF were significantly lower(P<0.05)in hemodialysis group than those in control group before hemodialysis.LVESV,LVEDV,LVSV,RVESV and RVEDV were improved(P<0.05)and RVEF and RRVEF decreased significantly(P<0.05)in hemodialysis group after hemodialysis for 3 months.The results of Spearman correlation analysis showed that cardiovascular adverse events were significantly correlated to REF and rRVEF(P<0.05).Conclusion Hemodialysis therapy can improve left ventricular function but had some adverse influence on right ventricular systolic function in ESRF patients.RT-3DE has the advantages including simple in operation,fast and accurate in examination,and it can diagnose early the global heart function in ESRF patients.RT-3DE can quantitativel

关 键 词：终末期肾衰 血液透析 实时三维超声心动图 心室功能 

分 类 号：R540.45[医药卫生—心血管疾病]