【作者】 段东奎；

【导师】 张桂敏； 倪锐志；

【作者基本信息】 昆明医学院 ， 外科学， 2008， 硕士

【摘要】 目的:应用常规经胸超声心动图(TTE)和新技术定量组织多普勒成像(QTVI)评价室间隔缺损(VSD)修补术前、术后3天、术后1个月、术后3个月血流动力学、心腔负荷和心脏收缩及舒张功能的变化。方法:对30名成功实行室间隔缺损修补术患者及30正常对照组进行进行常规超声心动图及定量组织多普勒研究,室间隔缺损患者分别于修补术前,术后3天、1个月及3个月进行检查。所有受检者取胸骨旁左心长轴测量左房(收缩末期)前后径,右室(舒张末期,收缩末期)前后径,左室(舒张末期,收缩末期)前后径。使用二维超声心动图,于心尖四腔切面测量左房(收缩末期)长径、横径,左室(舒张末期,收缩末期)长径、横径。于大血管短轴切面测量收缩期肺动脉中段内径。于心尖四腔切面通过勾画心内膜的方式,利用简化辛普森公式的方法测量左室收缩及舒张末期容积。使用多普勒频谱,于心尖四腔切面获取二尖瓣口血流血流频谱,测量舒张早期E峰,舒张晚期A峰反映左心舒张功能及左心容量,于大血管短轴切面测量收缩期肺动脉瓣口最大血流速度(Vmax)、平均血流速度(Vmean)、速度时间积分(VTI)反映右心容量。取心尖四腔切面,启用量组织多普勒(QTVI)功能分别测量受检者室间隔二尖瓣环处、室间隔中部、右室侧壁三尖瓣环处、右室侧壁中部、左室侧壁二尖瓣环处、左室侧壁中部的收缩波(S’)、舒张早期波(E’)和舒张晚期波(A’),以此反映受检者的局部心肌功能。研究室间隔缺损患者术前及术后各时段以上各指标与正常对照组的差别,以及术后各阶段与术前各指标的差别。结果:VSD修补治疗术后3天、1个月、3个月的变化:①腔室负荷变化,术后3个月右室舒张末横径、肺动脉中段内径较术前减小,差异有统计学意义(P＜0.05);术后1个月,左房收缩末期前后径、左室舒张末及收缩末期前后径、横径及左室舒张末期容积较术前均减小,差异有统计学意义(P＜0.05);术后3个月,所测左房、左室径及左室收缩末期容积均有明显减小,差异有统计学意义(P＜0.05)。②血流动力学变化,VSD修补术后心室水平左向右分流消失;与术前比较,术后3天、1个月、3个月、肺动脉瓣口Vmax,Vmean,VTI以及二尖瓣E峰、A峰值血流速度明显减低,差异有显著性意义(P＜0.05);与正常组比较,上述数据同样有统计学差异性(P＜0.05)。③TDI观测心功能变化,左室侧壁中部术后1个月及3个月E’峰及术后3个月A’峰略升高,差异有统计学意义(P＜0.05);除此之外,其它所有取样点的各峰速度均增高趋势,但无统计学差异性(P＞0.05),;E’/A’术前、术后无明显变化。结论:本研究显示:TTE和QTVI在正常组及VSD修补术前、后的疗效观察中具有非常重要的作用。VSD外科修补术治疗后改变了患者血流动力学异常,使心腔前负荷增加得以纠正,改善了异常心腔形态和几何构形,基本恢复了左、右心室的正常收缩与舒张功能。更多还原

【Abstract】 Objective:To evaluate the changes of hemodynamics,cardiac chamber load and systolic and diastolic function and after ventricular septal defect(VSD)neoplasty by using transthoracic echocardiography(TTE)and Quantitative Tissue Velocity Imaging(QTVI).Methods:TTE and QTVI were performed in 30 patients with the VSD successfully neoplasty from April,2007 to October,2007 before neoplasty and three days,one month and three months after neoplasty.The spectriam of tricuspid and mitral valves were recorded by placing sample volume of pulsed wave Doppler on orifice of tricuspid and mitral valves on apical four chamber view,and spectrium of pulmonary artery was recorded through pulmonary orifice on short axis view of great artery.E peak and A peak velocities of tricuspid and mitral valves,and maximal,mean velocities and velocity-time integral of pulmonary artery were measured.The anterior-posterior diameters,left-right diameters and long diameters of left ventricle both in systole and diastole were respectively measured on short axis view of left ventricle in tendon cordal level and apical four chamber view.The long diameter of left ventricle in diastole and systole,the long and traverse diameters of left and right atrium in systole were measured on four chamber view.The antieror-postieror diameter of right ventricular in diastole Antieror-postieror diameter of left atrium in systole were measured on parasternal long axis view.The diameter of pulmonary artery was measured on short axis of great vessel by using two-dimensional echocardiography.The volume of left ventriculer in end-systolic and end-diastolic period were also measured by using Simpson’s equation with tracing endocardium on apical four chamber view.With QTVI, the velocities on annular and middle parts of left and right ventricular lateral wall and ventricular septum were measured on apical four chamber view.Take all the mearsures above about 30 normal persons.Results:Involved change after VSD neoplasty on third day,third month and sixth month①Hemodynamic change:Left to right shunt in ventricular level disappeared after neoplasty.Compared with the data before neoplasty,E and A peak velocities of mitral valve and maximal and mean velocities,velocity-time integral of pulmonary artery were remarkably decreased(P＜0.001),Compared with the data normal persons,the above data decreased(P＜0.05).②The change of chamber load:Left-right diameter of fight ventricle was significantly reduced on 3 days,1 months and 3 months after neoplasty(P＜0.05).Antieror-postieror diameter of left atrium in systole antieror-postieror diameter and left-right diameter as well as end-diastolc volume of left ventricle were significantly markedly decresed on 3 days after neoplasty(P＜0.05).All diameters of left atrium and left ventricle,and end-systolic volumes of left ventricle were significantly reduced on 1 and 3 months(P＜0.05).③The change of cardiac function measured by TDI:E’ velocity on middle part of left ventricular lateral wall on 1 and 3 months and A’ velocity on middle part of left ventricular lateral wall on 3 months were significantly increased(P＜0.05).But,there were no significantly change on all the other wall velocity.Conclusion:TTE and QTVI are simple and valuable methods to observe on the effect of VSD neoplasty,which may provide useful information for clinical doctors.They are on observing hemodynamic,cardiac chamber and function changes before and after neoplasty.This study shows that abnormal hemodynamics,increased preload and it’s morphological abnormality,as well as systolic and diastolic function of right ventricle observed by the use of TTE and QTVI after VSD neoplasty.更多还原