【作者】 李蔚；

【导师】 谢明星； 李玲；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 第一部分超声斑点追踪技术评价正常妊娠妇女左室整体旋转与扭转运动目的应用二维斑点追踪成像(Speckle Tracking Imaging,STI)技术评价正常妊娠妇女不同孕期左室心肌整体旋转与扭转运动变化特征。方法选取不同妊娠期妇女84例、健康未孕女性为对照组28例,分别采集左室心底水平(MV)、心尖水平(AP)短轴二维图像,运用STI软件进行脱机分析,记录左室整体扭转角度峰值(Peak twist, Ptw)、心底水平旋转角度峰值(Peak rotation-MV, Prot-MV)、达峰绝对时间(Peak time-MV, Pti-MV)、达峰时间百分比(Percent of Peak time-MV, Perc-Pti-MV)、心尖水平旋转角度峰值(Peak rotation-AP, Prot-AP)、达峰绝对时间(Peak time-AP, Pti-AP)及达峰时间百分比(Percent of Peak time-AP, Perc-Pti-AP)。结果①妊娠组与对照组比较:左室心肌扭转运动随心动周期变化的曲线呈规律性变化,且形态基本一致。②分别与对照组比较,早、中妊娠组Ptw、Prot-AP测值增大,晚期妊娠组Ptw、Prot-AP测值减小,差异有统计学意义(P<0.05);与早期妊娠组比较,中期妊娠组Ptw、Prot-AP测值增大,晚期妊娠组Ptw、Prot-AP测值减低,差异有统计学意义(P<0.05)。晚期妊娠组与中期妊娠组比较Ptw、Prot-AP测值减小,差异有统计学意义(P<0.05);各组间Prot-MV比较差异无统计学意义(P>0.05)。③分别与对照组比较,早、中、晚期妊娠组Perc-Pti-AP及晚期妊娠组Perc-Pti-MV测值增大,差异均有统计学意义(P<0.05);与早期、中期妊娠组比较,晚期妊娠组Perc-Pti-MV增大,差异有统计学意义(P<0.05)。④Ptw与BSA、Prot-AP有相关性,与HR、身高、Prot-MV、LVEDV、LVEF无相关性。结论随着孕周数增加,妊娠期妇女左室收缩功能正常时,左室扭转与旋转运动已出现变化,且变化趋势不同。第二部分超声斑点追踪技术评价妊娠妇女左心室各节段室壁旋转运动目的应用STI技术评价正常妊娠期妇女左室心底、心尖各室壁节段旋转运动特征。方法研究对象、图像采集均同第一部分。结果①对照组内,左室心底各节段旋转角度测值比较显示:下壁、后壁测值最大,后间隔、侧壁次之,前壁、前间隔最小;前壁、前间隔与下壁、后壁比较,差异有统计学意义(P<0.05)。心尖各节段旋转角度差异无统计学意义(P>0.05)。②同一妊娠期,心底平面各节段旋转峰值差异有统计学意义(P<0.05);不同妊娠期,心底平面各节段旋转角度峰值比较,差异有统计学意义(P<0.05)。③同一妊娠期,心尖平面各节段旋转角度峰值差异无统计学意义(P>0.05);不同妊娠期,心尖平面各节段旋转角度峰值比较,各节段峰值之间差异有统计学意义(P<0.05),且随着孕周增加,出现妊娠早、中期增加,晚期减低的趋势。结论左室心底水平整体扭转随孕周无差异,心肌各节段室壁旋转角度随孕周的增加呈不同的变化趋势。左室心尖水平整体扭转随孕周增加,而心肌各节段室壁旋转角度变化一致。更多还原

【Abstract】 Part 1: Evaluation of left ventricular global rotation and twist in normal pregnant women by ultrasound speckle tracking imagingObjectives To evaluate left ventricular global rotation and twist in normal pregnant women by ultrasound speckle tracking imaging.Methods Eighty-four pregnant women and 28 normal women volunteers were collected in the study. Pregnant women were divided into three groups by gestational weeks: early pregnancy group (EP group), middle pregnancy group (MP group) and late pregnancy group (LP group). Basal and apical short-axis images of left ventricle were acquired to analysis left ventricular rotation(LVrot) and twist(LVtw). Ptw, Prot, Pti and Pre-Pti were measured respectively in the two short-axis imagings and the values of the above parameters were compared. Left ventricular torsion angle peak(Peak twist, Ptw), Basal levels of rotation peak(Peak rotation-MV, Prot-MV), peak absolute time(Peak time-MV, Pti-MV), peak time percentage(Percent of Peak time-MV, Perc-Pti-MV), apical levels of rotation peak level(Peak rotation-AP, Prot-AP), peak absolute time(Peak time-AP, Pti-AP)and time to peak percentage(Percent of Peak time-AP, Perc-Pti-AP) were recorded. The correlation between left ventricular rotation parameters and height, weight, heart rate, ejection fraction, LVEDV were compared.Results①The curve shapes of the LVrot and LVtw of the pregnant women were same with the one in normal.②Compared with control group, Ptw, Prot-AP increased significantly (P<0.05) in EP and MP groups and decreased significantly in LP (P<0.05). Compared with EP group, Ptw, Prot-AP increased significantly in MP group(P<0.05) and dereased significantly in LP group(P<0.05). Compared with LP and MP groups, Ptw、Prot-AP decreased significantly in LP group(P<0.05).③Compared with control group, Perc-Pti-AP increased significantly(P<0.05) in EP and MP groups, while Perc-Pti-MV and Perc-Pti-AP increased significantly(P<0.05) in LP groups. Compared with EP and MP groups, Perc-Pti-MV increased significantly (P<0.05) in LP group.Conclusions The left ventricular systolic torsion and twist had already changed in normal pregnancy when left ventricular systolic function maintained mormal. And with pregnancy progressing, it had showed different trends.Part 2. Evaluation of left ventricular regional rotation in normal pregnant women by ultrasound speckle tracking imagingObjectives To evaluate left ventricular regional rotation in normal pregnant women in pregnancy progress by ultrasound speckle tracking imaging.Methods Object of study, image acquisition were the same with the first part . Segmental and global LV rotation were recorded at both apical and basal short-axis views.Results:①Basal segmental rotation showed significant different heterogeneity in the control group(P<0.05). Segmental rotation in left ventricular short-axis at the apical level was similar(P>0.05).②In the same pregnant group, segmental rotation of apical level had no significant difference(P>0.05); in different pregnant groups, segmental rotation of apical level had statistically significant difference(P<0.05).③In the same pregnant group, regional rotation of basal level had significant difference(P<0.05), And in different pregnant group, basal level rotation had no statistically significant difference(P>0.05).Conclusions With the increase of gestational weeks, the basal and apical segmental totation showed different trends.更多还原