二维斑点追踪技术评价射频消融肾交感神经的安全性

摘要

目的 用超声二维斑点追踪技术检测肾动脉交感神经经导管射频消融后对心脏的影响.方法 对20只犬的肾交感神经进行射频消融,分别于消融前和消融6周后观察肾交感神经消融犬的血压变化及心脏指标变化.采集犬心尖两腔观、三腔观、四腔观及胸骨旁左室短轴观二尖瓣水平、乳突肌水平的清晰图像,用Qlab软件测量各切面二尖瓣水平和乳突肌水平各节段自QRS起点至收缩期峰值应变,推算左室12节段纵向、径向及环向应变达收缩期峰值时间和达峰值时间标准差,12节段纵向达收缩期峰值应变.比较消融前后各参数.结果 与肾交感消融前相比,消融组犬消融后收缩压和舒张压均未见明显降低(P＞0.05).消融前后犬左室12节段纵向达峰期峰值应变差异无统计学意义(P＞0.05),左室纵向、径向、环向收缩期达峰时间差异无统计学意义(P＞0.05),左室纵向、径向、环向收缩期达峰时间标准差差异无统计学意义(P＞0.05).消融前后心脏各腔室大小无明显变化(P＞0.05).结论 消融犬肾交感神经后收缩压及舒张压均未降低,犬肾交感神经射频消融前后心脏各腔室、心肌收缩功能及心脏同步性均无明显变化,说明消融肾交感神经不降低正常血压,且对心脏是安全的.%Objective To evaluate the security of catheter-based renal denervation by two dimensional speckle tracking imaging.Methods 20 dogs was ablated,whose indicies of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views as well as the parasternal short-axis views at the level of the mitral valve and papillary muscles.The time to peak-systolic strain of each segment in the level of the mitral valve and papillary muscles,the standard deviation of the time to peak-systolic strain,the peak strain of the longitudinal 12-segment were recorded.Parameters were compared among the before and after ablation.Results Compared with before ablation of renal sympathetic nerve,the systolic pressure and diastolic pressure didn't reduced significantly after the ablation of renal sympathetic nerve (P ＞ 0.05),while there were no significant difference in the peak strain of the longitudinal 12-segment,the dyssychrony parameters and the size of the heart cavity before and after ablation(P ＞0.05).Conclusions The pressure had no change after the ablation of renal sympathetic nerve while without harmful effect on the the size of the heart cavity,the function of the myocardial contraction and the dyssychrony parameters.The ablation of renal sympathetic nerve can' t lower the normal blood pressure and be safe for heart at the same time.