超声心动图评价动脉瘤性蛛网膜下腔出血患者心脑功能损伤程度的前瞻性研究  

Echocardiographic evaluation of neurocardiac injury in patients with aneurysmal subarachnoid hemorrhage:a prospective study

作　　者：齐治 赵翀翀[2] 刘雪梅 曲志成[3] 陈鹏[4] 袁芳[4] 王颖[1] 陈斯丹 谭篪[1] 董鑫 QI Zhi;ZHAO Chongchong;LIU Xuemei;QU Zhicheng;CHEN Peng;YUAN Fang;WANG Ying;CHEN Sidan;TAN Chi;DONG Xin(Department of Ultrasound,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Neurology,The Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Emergency,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Acupuncture,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Ultrasound,Shunyi Hospital,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 101300,China.)

机构地区：[1]首都医科大学附属北京中医医院超声科,北京100010 [2]兰州大学第二医院神经内科,甘肃兰州730030 [3]首都医科大学附属北京中医医院急诊科,北京100010 [4]首都医科大学附属北京中医医院针灸科,北京100010 [5]首都医科大学附属北京中医医院顺义医院超声科,北京101300

出　　处：《分子影像学杂志》2024年第1期42-46,共5页Journal of Molecular Imaging

基　　金：首都医科大学附属北京中医医院两院课题(LY201808)。

摘　　要：目的应用超声心动图评价动脉瘤性蛛网膜下腔出血(aSAH)发生后早期及晚期心脏功能的变化。方法纳入2018年5月~2023年5月于首都医科大学附属北京中医医院确诊为aSAH的患者83例。按心肌肌钙蛋白(cTnI)水平将其分为高cTnI组(cTnI≥0.3 ng/mL,n=25)及低cTnI组(cTnI<0.3 ng/mL,n=58)。超声心动图评价左室长轴应变及径向应变。分别计算得出整体长轴应变(GLS)及每个节段长轴应变达峰时间变异程度(LT-Dispersion)、每个节段径向应变达峰时间变异程度(RT-Dispersion)及乳头肌水平左室短轴切面左室前间隔与左室后壁径向应变达峰时间差值(APT)。结果发生后早期高cTnI组LT-Dispersion、RT-Dispersion、APT及GLS受损更为显著(P<0.05);2组发生后晚期LT-Dispersion、RT-Dispersion、APT及GLS较发生后早期有明显改善(P<0.05),低cTnI组改善程度较高cTnI组更显著(P<0.05)。结论GLS及反映左室局部运动不协调的指标LT-Dispersion、RT-Dispersion及APT与表现为cTnI升高的aSAH心脑损伤密切相关。超声心动图评价动脉瘤性蛛网膜下腔出血患者心脑功能损伤程度具有重要的临床应用价值。Objective To discuss changes in cardiac function from early stage after aneurysmal subarachnoid hemorrhage(aSAH)to shortly later stage using echocardiography.Methods We prospectively studied 83 patients with aSAH in Beijing Hospital of Traditional Chinese Medicine from May 2018 to May 2023.These patients were divided into the highly positive cTnI group(cTnI≥0.3 ng/mL,n=25)and the mildly positive cTnI group(cTnI<0.3 ng/mL,n=58)according to cTnI level.Longitudinal strain and radial strain were acquired by strain echocardiography.Global longitudinal strain(GLS),the standard deviation of time-to-peak longitudinal strain from LV segments(LT-Dispersion),the standard deviation of time-to-peak radial strain from LV segments(RT-Dispersion)and the time-to-peak radial strain difference between LV anterior septum and posterior wall in left ventricular short axis view at papillary muscle level(APT)were measured and calculated.Results At early stage,LT-Dispersion,RT-Dispersion,APT and GLS in highly positive cTnI group were associated with more serious neurocardiac damage than others(P<0.05).Improvements(later stage vs early stage)of GLS,LT-Dispersion,RT-Dispersion and APT were more significantly better in the mildly positive cTnI group than in the highly positive cTnI group(P<0.05).Conclusion GLS and left ventricular regional discoordination measured by LT-Dispersion,RT-Dispersion and APT were significantly associated with neurocardiac injury severity after aSAH as reflected by elevated cTnI.Novel echocardiographic analysis to detect neurocardiac injury severity in patients with aSAH has promise for clinical utility.

关 键 词：蛛网膜下腔出血 动脉瘤性 心脑功能损伤 超声心动图 

分 类 号：R743.35[医药卫生—神经病学与精神病学]