经胸超声心动图在左心室辅助装置置入术围手术期中的应用  

Clinical application value of transthoracic echocardiography during perioperative period in patients undergoing left ventricular assist device implantation

作　　者：施怡声[1] 牛丽莉[1] 朱振辉[1] 梁玉[1] 王浩[1] 杜娟[2] 王现强[3] 陈海波[3] 胡盛寿[3] Shi Yisheng;Niu Lili;Zhu Zhenhui;Liang Yu;Wang Hao;Du Juan;Wang Xianqiang;Chen Haibo;Hu Shengshou(Ultrasound Imaging Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Postoperative Recovery Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Adult Cardiac Surgery Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院超声影像中心,100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院术后恢复中心,100037 [3]国医学科学院,北京协和医学院,国家心血管病中心,阜外医院成人心脏外科中心,100037

出　　处：《中华心血管病杂志》2021年第6期610-614,共5页Chinese Journal of Cardiology

摘　　要：目的观察经胸超声心动图(TTE)参数在左心室辅助装置(LVAD)置入术前、后的变化,探讨TTE在LVAD置入术围手术期中的临床运用价值。方法本研究为回顾性研究,纳入2018年1月至2020年12月在中国医学科学院阜外医院置入LVAD的终末期心力衰竭患者。收集患者的临床基本信息,采集并分析LVAD置入前1周及置入后1个月的TTE参数及血清N末端B型利钠肽原(NT-proBNP)和总胆红素(TBil)水平。结果本研究共纳入12例置入LVAD的患者,均为男性,年龄(43.3±8.6)岁。置入LVAD后1个月,患者的左心房容积指数[(41.4±12.8)ml/m^(2)比(74.9±30.7)ml/m^(2),P<0.001]、左心室舒张末容积指数[(152.1±35.3)ml/m^(2)比(205.5±35.7)ml/m^(2),P<0.001]、左心室收缩末容积指数[(112.5±27.9)ml/m^(2)比(155.1±29.1)ml/m^(2),P<0.001]、右心房横径指数[(23.7±3.5)mm/m^(2)比(27.2±5.8)mm/m^(2),P=0.023]、右心室舒张末期前后径[(24.6±2.7)mm比(30.0±4.8)mm,P<0.001]、三尖瓣环收缩期位移[(11.5±2.9)mm比(14.6±2.8)mm,P=0.007]、肺动脉收缩压[(29.2±4.8)mmHg比(55.1±19.3)mmHg,P<0.001,1 mmHg=0.133 kPa]均较置入前降低。而主动脉窦部内径[(33.8±4.7)mm比(31.6±5.1)mm,P=0.007]、左心室射血分数[(26.3±3.0)%比(23.8±4.4)%,P=0.016]、右心室面积变化分数[(31.0±8.6)%比(23.8±5.5)%,P=0.004]均较置入前增加。二尖瓣、三尖瓣反流程度降低,下腔静脉吸气塌陷率增大(P均<0.05)。NT-proBNP[(1418.4±812.6)ng/L比(5097.5±3940.4)ng/L,P=0.004]及TBil[(12.4±5.4)μmol/L比(27.5±14.0)μmol/L,t=4.284,P=0.001]较术前明显降低。结论TTE显示LVAD置入后左心有效卸负荷,右心功能改善;TTE可在围手术期监测患者的心脏结构和功能变化,为临床评估LVAD治疗效果提供依据。Objective To observe the changes of parameters derived from transthoracic echocardiography(TTE)before and after left ventricular assist device(LVAD)implantation,and to evaluate the clinical value of TTE in the perioperative period of LVAD implantation.Methods This is a retrospective study.The data of patients who underwent LVAD implantation in Fuwai Hospital from January 2018 to December 2020 were analyzed retrospectively.The TTE parameters,N-terminal pro-B-type natriuretic peptide(NT-proBNP)and total bilirubin(TBil)before and 1 month after LVAD implantation were collected and analyzed.Results A total of 12 male patients undergoing LVAD implantation were included in this study.The mean age was(43.3±8.6)years.The left atrial volume index((41.4±12.8)ml/m^(2)vs.(74.9±30.7)ml/m^(2),P<0.001),left ventricular end-diastolic volume index((152.1±35.3)ml/m^(2)vs.(205.5±35.7)ml/m^(2),P<0.001),left ventricular end-systolic volume index((112.5±27.9)ml/m^(2)vs.(155.1±29.1)ml/m^(2),P<0.001),right atrial diameter index((23.7±3.5)mm/m^(2)vs.(27.2±5.8)mm/m^(2),P=0.023),right ventricular internal diameter at end-diastole((24.6±2.7)mm vs.(30.0±4.8)mm,P<0.001),tricuspid annular plane systolic excursion((11.5±2.9)mm vs.(14.6±2.8)mm,P=0.007),systolic pulmonary arterial pressure((29.2±4.8)mmHg vs.(55.1±19.3)mmHg,P<0.001,1 mmHg=0.133 kPa)were significantly reduced at 1 month post LVAD implantation as compared to before LVAD implantation.The aortic sinus diameter((33.8±4.7)mm vs.(31.6±5.1)mm,P=0.007),left ventricular ejection fraction((26.3±3.0)%vs.(23.8±4.4)%,P=0.016),right ventricular fractional area change((31.0±8.6)%vs.(23.8±5.5)%,P=0.004)at 1 month post LVAD implantation were significantly higher than before LVAD implantation.The degree of mitral and tricuspid regurgitation decreased,and the inspiratory collapse rate of inferior vena cava increased(all P<0.05).NT-proBNP((1418.4±812.6)ng/L vs.(5097.5±3940.4)ng/L,P=0.004)and TBil((12.4±5.4)μmol/L vs.(27.5±14.0)μmol/L,P=0.001)decreased significantly at 1 month

关 键 词：心力衰竭 经胸超声心动图 左心室辅助装置 围手术期 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]