二维及三维心脏超声参数对心脏移植后心功能和形态的评估效果及预测效能研究  

Study on the Evaluation Effect and Predictive Effectiveness of Two-dimensional and Three-dimensional Ultrasound Parameters on Cardiac Function and Shape after Heart Transplantation

作　　者：吴文芳[1] 李妙[1] 董静[1] WU Wenfang;LI Miao;DONG Jing(Department of Cardiovascular Ultrasound,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu,P.R.China)

机构地区：[1]南京医科大学附属南京医院/南京市第一医院心血管超声科,江苏南京210006

出　　处：《影像科学与光化学》2020年第6期988-993,共6页Imaging Science and Photochemistry

摘　　要：为探讨二维及三维心脏超声评价心脏移植术后心功能和形态改变的应用价值,选取心脏移植术后患者41例设为观察组,另选取同期健康体检者41例设为对照组。观察组入院术后7 d均实施二维及三维心脏超声检查,发现患者的左房内径(LAD)、左心室收缩末期内径(LVESD)大于对照组,左心室射血分数(LVEF)小于对照组(P<0.05);随访3个月,观察组存在排异反应者的术后7 d LAD、LVESD、左室心肌质量(LVM)大于无排异反应者,LVEF、左室每搏量(LVSV)小于无排异反应者(P<0.05);随访3个月,病死者术后7 d的LAD、LVESD、LVM大于存活者,LVEF、LVSV小于存活者(P<0.05)。LAD、LVESD、LVEF、LVM、LVSV联合预测心脏移植术后患者排异反应及患者预后的AUC均为最大。本研究提示二维及三维超声参数对心脏移植后心功能、形态具有一定评估价值,有望成为预测心脏移植术后排斥反应和预后的潜在手段,指导临床采取合理治疗措施,改善患者预后。In order to explore the application value of two-dimensional and three-dimensional echocardiography in evaluating cardiac function and morphological changes after heart transplantation,a total of 41 patients underwent heart transplantation were selected as the observation group,and 41 patients underwent healthy physical examination during the same period were selected as the control group.7 days after surgery,two-dimensional and three-dimensional ultrasound examinations were performed.It was found that the left atrial inner diameter(LAD),left ventricular end-systolic diameter(LVESD)of the observation group were greater than those of the control group at 7 days after operation,and the left ventricular ejection fraction(LVEF)was lower than the control group(P<0.05).After 3 months of follow-up,LAD,LVESD and left ventricular mass(LVM)of those occurred rejection in the observation group were greater than those without rejection,and LVEF and left ventricular stroke volume(LVSV)were less than those without rejection(P<0.05).After 3 months of follow-up,LAD,LVESD,LVM of the deceased in the observation group were greater than those of the survivor,and LVEF and LVSV were less than those of the survivor(P<0.05).The combination of LAD,LVESD,LVEF,LVM and LVSV to predict the rejection and prognosis of patients after heart transplantation had the largest AUC.It is suggested that two-dimensional and three-dimensional ultrasound parameters have a certain evaluation value for cardiac function and morphology after heart transplantation,and they are expected to become a potential method to predict rejection and prognosis after heart transplantation,and to guide the reasonable treatment to improve the prognosis of patients.

关 键 词：二维超声 三维超声 心脏移植 心功能 排异反应 

分 类 号：R654.2[医药卫生—外科学] R445.1[医药卫生—临床医学]