【作者】 史琪；

【导师】 穆玉明；

【作者基本信息】 新疆医科大学 ， 内科学， 2011， 硕士

【摘要】 目的：应用实时三维超声心动图(RT-3DE)和二维斑点追踪显像(STI)技术对阵发性房颤患者左房(left atrial, LA)容积和心肌的运动及变形功能进行评价；并对经导管射频消融术治疗前后左房重构和功能的改变进行随访,旨在探讨STI在评价左房心肌功能方面的应用价值,以及经导管射频消融术对阵发性房颤患者左房形态及功能的影响,以便于指导临床治疗及预后评价。方法：1)分别选取30例正常人和30例行射频消融术阵发性房颤患者。进行常规超声心动图检查,所有患者于检查时均为窦性心律,分别应用常规二维超声、多普勒频谱、实时三维超声心动图采集患者心脏结构参数、二尖瓣血流频谱、肺静脉血流频谱、左心房容积指标及左房应变率曲线的参数,进行两组间比较；2)选取接受导管射频消融治疗阵发性房颤患者30例,应用超声心动图测定其消融术前及术后3天、3个月静息时窦性心律下左房的径线、二尖瓣血流频谱E波和A波的速度、E波与A波的速度比值(E/A)以及肺静脉血流频谱上S波、D波和A波的速度。应用RT-3DE计算左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVp)、左房被动射血分数(LAPEF)和左房主动射血分数(LAAEF);应用STI技术获取左房各壁各节段的应变率曲线,分别测量SRe、SRa。结果：1)与正常对照组相比,射频消融组左房各壁各节段SRs、SRe和SRa降低,左房后壁基底段、中间段和心底段SRa显著减小,射频消融组mLASRa与LAAEF呈显著正相关；2)与术前相比,射频消融术后3天左房各壁各节段SRs、SRe和SRa均降低；术后3个月左房前壁、下壁、房间隔的基底段和中间段SRa和SRe增高,SRs无明显差异,LAVmax、LAVp和LAVmin减小,LAPEF和LAAEF增高。结论：1.二维斑点追踪技术能无创及定量评价阵发性房颤患者左房整体及居部心肌的功能异常。2.阵发性房颤患者左房容积增大,左房各壁应变率峰值减低,左心房辅泵功能、管道功能和储蓄功能相互代偿的作用减弱或消失。3.射频消融术后三天,在房各壁各节段应变率较术前显著减低,提示左房功能处于“恶化期”。射频消融术后三个月,阵发性房颤患者的左房重构和功能得到部分改善,左房储存功能减低,辅泵功能和管道功能增高。更多还原

【Abstract】 Objective:To evaluate left atrial (LA) function by real-time three-dimensional echocardiography (RT-3D) and speckle tracking imaging (STI) after circumferential ablation of pulmonay vein ostia for atrial fibrillation guided by carto mapping system. Methods:1) The Patients were divided into the group with PAF (n=30) and the group with sinus rhythm (n=30). No Patients with significant dyskinetic cardiac chamber, Systolic dysfunction of LV, valve disease or regional wall motion abnormality were included. Parameters derived from the routine 2D ultrasound, mitral flow pattern, pulmonary vein flow patter, left atrial volume and the strain rate; 2) Thirty patients who had ablation procedure for paroxysmal atrial fibillation were accepted echocardiograpy to estimate the LA function at pre-operation,3 days and 3 months of post-operation. The LA maximal, minimal and pre-systolic volume (LAVmax, LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured by RT-3DE respectively. The strain rate curve was acquired in each LA segment (anterior, posterior, lateral, inferior and septal) by STI. Results:1) Compared with the control group, the SRs, SRe and SRa in PAF group decreased in each wall of LA. The SRa of basal, middle, bottom of the posterior were reduced. A significant relation between mLASRa and LAAEF in PAF group; 2) Comparing with preoperative,3 days post-ablation SRs、SRe and SRa decreased significantly in each wall of LA.After 3 months, a significant reduction in LAVmax,LAVpre and LAVmin and a significant improvement in LAPEF and LAAEF. Conclusions 1.STI are readily obtained parameters that provide unique data about atrial function.2.The strain rate of each wall of Left atrial decreased in paroxysmal atrial fibrillation patients, the mutual Compensatory function of the pump function, conduit functions and reservoir function were weakened and disappeared.3.The patients with circumferential pulmonary vein ablation were be in a deterioration after three days. The pump function and conduit functions of left atrial were increased after 3 months.更多还原