实时三维超声心动图评价慢性阻塞性肺疾病患者右心室功能的研究

摘要

目的 应用实时三维超声心动图(RT-3DE)定量评价慢性阻塞性肺疾病(COPD)患者的右心室功能,并讨论右心室功能的受损程度与疾病严重性的关系.方法 30例COPD患者,其中男24例,女6例,年龄(56±20)岁,均在1周内行肺功能检测及RT-3DE检查.根据GOLD标准将所有患者分成三组:Ⅰ组10例(轻度,50%≤FEV1占预计百分比<80%),Ⅱ组10例(中度,30%≤FEV1占预计百分比<50%),Ⅲ组10例(重度,FEV1占预计百分比<30%).10例健康成年志愿者作为对照组,其中男6例、女4例,年龄(48±21)岁.行RT-3DE全容积显像方式采集图像数据,并导入TomTec工作站,应用4D RV-function软件行图像后处理,构建右心室三维模型并进行心功能测量.用Pearson相关分析检验右心室功能测量结果[舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、右心室射血分数(EF)]与肺功能结果的相关性.结果 肺功能指标第一秒用力呼气量(FEV1)、第一秒用力呼气容积与用力肺活量比值(FEV1/FVC)与右心室功能各指标有显著相关性.结论 RT-3DE测得的COPD患者右心室功能指标与肺功能指标相关性高,在COPD患者右心室功能评价中具有广阔的应用前景.%Objective To conduct a quantitative evaluation of the right ventricular (RV) function of patients with chronic obstructive pulmonary disease (COPD) with using realtime three dimensional echocardiography, and investigate the relationship between the damage degree of the RV function and the severity of the disease. Methods PFT measurement and realtime three dimensional echocardiography were performed in one week in 30 patients[with 24 males and 6 females,ages range in (56±2O)] of COPD. And all the patients were divided into 3 groups according to the Chronic Obstructive Lung Disease (GOLD) standard: group I (mild,50%≤FEVl percentage of predicted＜80%) ,group Ⅱ (moderate, 30%≤FEV1 percentage of predicted＜50%) ,and group HI (severe,FEV1 percentage of predicted ＜ 30%). There were 10 healthy adult volunteers in the control group[with 6 males and 4 females,ages range in (48±21)]. The image data were selected through realtime three dimensional echocardiography full-volume imaging,imported to TomTec workstation,and dealt with 4D RV-function for image post-processing,then built a three dimensional modal of the right ventricle and measured the cardiac function. The correlation between the measurement result of RV function (EDV,ESV,SV and EF) and the result of lung function were analyzed by Pearson method. Results FEV1 and FEV1/FVC were significantly associated with RV function index. Conclusion The RV function index of COPD patients measured by realtime three dimensional echocardiography was significantly correlated with lung function index. It is a valuable method for evaluating the right heart function of COPD patients.