经食道超声斑点追踪技术评估老年冠状动脉旁路移植术病人左心舒张功能的研究  

Intraoperative assessment of left-ventricular diastolic function by transesophageal speckle tracking echocardiography in elderly patients undergoing off-pump coronary artery bypass graft surgery

作　　者：龚婵娟 桂波 朱琳佳 GONG Chan-juan;ZHU Lin-jia;GUI Bo(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Anesthesiology,Jiangsu Province Official Hospital,Nanjing 210024,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏省南京市210029 [2]江苏省省级机关医院麻醉科,江苏省南京市210024

出　　处：《实用老年医学》2022年第5期441-444,共4页Practical Geriatrics

摘　　要：目的探讨经食道超声斑点追踪技术对老年不停跳冠状动脉旁路移植术(off-pump coronary artery bypass graft,off-pump CABG)病人血运重建前后左心舒张功能的评价作用。方法选择2020年5月1日至12月30日行off-pump CABG的病人49例,分别在T_(0)(探头放置后5 min)、T_(1)(冠状动脉血运重建后30 min)2个时间点,使用彩色多普勒超声诊断仪留取连续3个心动周期经食道中段四腔心、两腔心、三腔心图像,并转存入工作站描记等容舒张期应变率(strain rate during isovolumic relaxation,SR_(IVR))、舒张早期应变率(strain rate during early diastole,SRe)以及舒张晚期应变率(strain rate during late diastole,SRa)。比较冠脉血运重建前后病人左心舒张功能变化。分析各舒张时期应变率指标(strain based indices,SBIs)与肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)的相关性及SR_(IVR)、SRe、SRa预测PCWP增高的诊断效能。结果冠脉血运重建后,病人SR_(IVR)与SRa明显改善(P<0.05)。T_(0)、T_(1)时间点的SR_(IVR)与PCWP均呈负相关(r=-0.78、-0.72,均P<0.001);T_(0)与T_(1)时间点SR_(IVR)预测PCWP≥12 mmHg的AUC分别为0.88与0.89。结论经食道超声斑点追踪技术检测舒张时期应变率指标可以早期、敏感、准确地反映off-pump CABG老年病人血运重建后左心舒张功能变化,具有良好的临床应用前景。Objective To explore the evaluation of left-ventricular diastolic function by transesophageal speckle tracking echocardiography after revascularization in the elderly patients undergoing off-pump coronary artery bypass grafting(off-pump CABG).Methods A total of 49 elderly patients undergoing off-pump CABG were recruited.Transesophageal echocardiography examination was performed at T_(0)(5 min after placement of the transesophageal echocardiography probe)and T_(1)(30 min after revascularization).The four-,two-,and three-chamber views were obtained for 3 cardiac cycles,and then copied to a Philips QLab workstation.Strain rate during isovolumic relaxation(SR_(IVR)),strain rate during early diastole(SRe)and strain rate during late diastole(SRa)were analyzed.The changes of left-ventricular diastolic function after coronary revascularization were compared.The correlation between strain rate-based indices(SBIs)and pulmonary capillary wedge pressure(PCWP)was analyzed,and the predictive ability of SR_(IVR),SRe and SRa for the increase of PCWP was also evaluated.Results SR_(IVR) and SRa were significanly improved after revascularization(both P<0.05).At T_(0) and T_(1),SR_(IVR) was negatively correlated with PCWP(r=-0.78,-0.72,all P<0.001).At T_(0) and T_(1),SR_(IVR) showed a strong ability to predict PCWP≥12 mmHg(AUC=0.88,0.89).Conclusions Strain based indices were more sensitive and accurate predictors for the increase of PCWP,which has a good prospect in clinical application.

关 键 词：经食道超声心动图 斑点追踪技术 不停跳冠状动脉旁路移植术 等容舒张期应变率 老年人 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654[医药卫生—诊断学]