驻不同海拔高度高原人员习服后心脏结构和功能变化的超声心动图评估  

Assessment of left and right ventricular morphology and function after acclimatization at different altitudes by echocardiography

作　　者：吴赤球[1] 韦曙东 张辉[4] 严许清 梅朵卓嘎 余丹[2] Wu Chiqiu;Wei Shudong;Zhang Hui;Yan Xuqing;Meiduo Zuoga;Yu Dan(Department of Medical Imaging,Zhejiang Provincial Corps Hospital,Chinese Peoples Armed Police Force,Hangzhou 310051,China;Second Department of Internal Medicine,Zhejiang Provincial Corps Hospital,Chinese Peoples Armed Police Force,Hangzhou 310051,China;Department of Medical Imaging,the Second Mobile Corps Hospital,Chinese Peoples Armed Police Force,Wuxi 214000,China;Third Department of Internal Medicine,Jiangsu Provincial Corps Hospital,Chinese Peoples Armed Police Force,Yangzhou 225000,China;Health Team of 3th Traffic Detachment,the Second Mobile Corps,Chinese Peoples Armed Police Force,Linzhi 860300,China)

机构地区：[1]武警浙江省总队医院医学影像科,杭州310051 [2]武警浙江省总队医院内二科,杭州310051 [3]武警第二机动总队医院医学影像科,无锡214000 [4]武警江苏省总队医院内三科,扬州225000 [5]武警第二机动总队交通第三支队卫生队,林芝860300

出　　处：《中华医学超声杂志（电子版）》2023年第6期588-593,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用超声心动图观察驻不同海拔高度高原某部人员习服后心脏结构和功能参数变化情况。方法前瞻性纳入2021年6月至2021年7月高原某部共计302名人员为研究对象,按照驻扎海拔高度不同分为A组(2500~3000 m)78例、B组(3001~4000 m)49例、C组(4001~5000 m)175例。对3组进行超声心动图检查,二维超声测量心脏各房室腔径线大小及室壁厚度,彩色多普勒及脉冲多普勒超声测量二尖瓣口和三尖瓣口血流频谱参数,组织多普勒超声测量二尖瓣环及三尖瓣环组织多普勒频谱参数,并对3组参数进行比较分析。结果不同海拔高度组心脏结构变化:左心室舒张末期内径、左心房前后径随海拔增高呈减小趋势,右心室舒张末期前后径、右心室游离壁厚度、右心房面积随海拔增高呈增加和扩大趋势,其中A组与B组、C组相比差异有统计学意义(P<0.05)。不同海拔高度组心脏功能变化:左心室收缩功能参数左心室射血分数、左心室短轴缩短率及右心室收缩功能参数三尖瓣侧壁瓣环位移、侧壁瓣环s峰值随海拔增高未见明显变化(P>0.05)。二尖瓣口和三尖瓣口的E峰随海拔增高呈逐步降低趋势,A峰呈逐步增加趋势,E/A比值呈逐步减低趋势,其中E峰和E/A比值A组与B组、C组相比差异有统计学意义(P<0.05)。组织多普勒e峰、a峰、e/a比值参数变化分别与E峰、A峰和E/A比值变化趋势一致。三尖瓣口E/A倒置比例A组与C组比较差异有统计学意义(P<0.05),三尖瓣侧壁瓣环e/a倒置比例各组相比差异均有统计学意义(P<0.05)。平均肺动脉压随海拔增高亦逐步增高,各组间相比差异有统计学意义(P<0.05)。结论随海拔增高,左、右心室的收缩功能参数无明显变化,而心脏形态、结构和舒张功能参数有不同程度改变,便携式彩色多普勒超声是评价高原环境下心脏形态、结构和功能变化情况的可行方法。Objective To assess the changes of cardiac structure and function after acclimatization at different altitudes on the plateau.Methods A total of 302 personnels at different altitudes on the plateau were included in the study between June 2021 and July 2021.According to different altitudes,they were divided into group A(2500 m-3000 m group,n=78),group B(3001 m-4000 m group,n=49),and group C(4001 m-5000 m group,n=175).Echocardiography was performed by an experienced sonographer,and the parameters of cardiac structure and function were measured using portable echocardiography in a quiescent state.Results The end-diastolic diameter of the left ventricle and left atrium decreased with increased altitude,while the end-diastolic diameter of the right ventricle,the thickness of the free wall of the right ventricle,and the area of the right atrium increased with altitude;the parameters of group A was statistically different from those of groups B and C(P<0.05).Parameters of right ventricular systolic function,including tricuspid annular plane systolic excursion and peak systolic velocity of the tricuspid annulus(s)were similar in the three groups.The left ventricular systolic function parameters left ventricular ejection fraction and left ventricular fraction shortening did not differ significantly among the three groups either.Mitral and tricuspid flow E waves and E/A ratios decreased,while A waves increased with higher altitude;the parameters of group A were statistically different from those of groups B and C(P<0.05).The changes of tissue Doppler parameters including E wave,A wave,and E/A ratio were consistent with those of the power Doppler parameters.The percentage of patients with E/A inversion of the tricuspid annulus was statistically different between group A and group C(P<0.05),and the percentage of patients with tissue Doppler e/a inversion of the tricuspid annulus was statistically different among the three groups;these changes of E/A inversion and e/a inversion were similar in the three groups(P>0.05).The mea

关 键 词：超声心动图 高原病 高海拔 心脏结构和功能 心血管系统 

分 类 号：R540.45[医药卫生—心血管疾病]