二维斑点追踪技术及实时三维超声心动图评价急性肺栓塞患者右心室收缩功能的临床研究

摘要

目的 应用二维斑点追踪(two-dimensional speckle tracking imaging,2D-STI)技术及实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价急性肺栓塞(acute pulmonaryembolism,APE)患者右室收缩功能的临床应用价值.方法 确诊的APE患者80例,依据早期病死率进行危险分层,将患者分为低危组(30例)、中危组(26例)和高危组(24例).正常对照组60例.应用2D-STI技术测量右室整体、右室游离壁及室间隔基底段、中间段和心尖段的纵向收缩期峰值应变(￡)值;应用RT-3DE测量右室舒张末期容积(RVEDV)、收缩末期容积(RVESV)、每搏输出量(RVSV)、射血分数(RVEF)和峰值排空率(PER).分析常规超声测值与2D-STI技术和RT-3DE测值之间的相关性.结果 ①APE患者较对照组右室整体、右室游离壁及室间隔各节段ε值减低,且随着危险程度增加其逐渐减低,其中以右室游离壁基底段和中间段减低最显著,差异有统计学意义(P＜0.05).②与对照组比较,中危组及高危组RVEDV、RVESV增高,RVEF、PER减低,低危组无明显变化,且随危险程度增加,RVEDV、RVESV逐渐增高,RVEF、PER逐渐减低,差异有统计学意义(P＜0.05).③APE组肺动脉收缩压(PASP)、三尖瓣环收缩期位移(TAPSE)与右室整体、右室游离壁各节段￡值及RVEF、PER之间有良好相关性,差异有统计学意义(P＜0.01).结论 APE患者右心功能受到了不同程度的损害,2D-STI技术及RT-3DE可以客观、准确、敏感地评价右室收缩功能的变化,有助于早期诊断及评价疗效.%Objective To investigate the right ventricular systolic function in patients with acute pulmonary embolism(APE) by two-dimensional speckle tracking imaging(2D-STI) and real-time three dimensional echocardiography(RT-3DE).Methods A total of 80 patients with APE were divided into 3 subgroups(the low risk group:including 30 patients;the moderate risk group:including 26 patients;the high risk group:including 24 patients) according to the expected pulmonary embolism-related early mortality.Sixty healthy subjects were served as controls.The longitudinal peak systolic strain (ε) values of RV global,septal and free wall for basal,mid and apical segments were measured by 2D-STI.The right ventricular end-diastolic volume (RVEDV),right ventricular end-systolic volume (RVESV),right ventricular stroke volume (RVSV),right ventricular ejection fraction (RVEF) and peak ejection rate (PER) were measured by RT-3DE.The correlations of measure values between the conventional ultrasound and 2D-STI or RT-3DE measurements in patients with APE were analyzed.Results ①In patients with APE,the ε of RV global,septal and free wall for basal,mid and apical segments were lower than those in the control group,and with the increase in the degree of risk,the ε of RV were gradually decreased,and ε of basal and mid segments of RV free wall were significantly reduced (P ＜0.05).②Compared with the control group,RVEDV,RVESV were increased and PER,RVEF were reduced in the high and moderate risk groups,while there were no significant alteration in low risk group.And with the increase in the degree of risk,RVEDV,RVESV were gradually increased and PER,RVEF were gradually reduced (P ＜0.05).(③)In patients with APE,PASP and TAPSE correlated well with RVEF,PER and the ε of RV global,all free wall segments.Conclusions Right ventricular systolic function in patients with APE was decreased to various levels.RT-3DE and 2D-STI can evaluate the changes of right ventricular function accurately in patients with APE,which are helpful to early diagnosis and evaluation of curative effect.