房颤患者左心耳结构功能的改变与左心耳血栓形成的关系探讨

摘要

目的：探讨心房颤动（房颤）患者左心耳的形态结构，左心耳的功能改变与左心耳血栓形成的关系及临床意义。方法：采用经食管三维超声心动图检测114例房颤组患者及54例对照组的左心耳开口面积（ LAA－O）、左心耳长径（LAA－L）、左心房容积（LA－V）、左心耳容积（LAA－V）、左心耳血流速度（LAA－v）及左心耳射血分数（LAA－EF）。进一步将房颤组分为无自发显影组（ NSEC组）、自发显影组（ SEC组）及血栓组（ TH组）3个亚组。并将各指标与对照组进行比较，同时观察房颤各亚组之间指标变化，并进行统计学分析。结果：房颤患者的左心耳开口面积、左心耳长径、左心房容积、左心耳容积均高于非房颤患者。房颤患者的左心耳血流速度、左心耳射血分数低于非房颤患者。房颤组组内各观察指标有以下变化：TH组左心耳容积、左心耳开口面积及左心房容积大于NSEC组（ P＜0畅05）；3组间左心耳长径、左心耳射血分数有显著性差异（P＜0畅05）；TH组及SEC组左心耳血流速度明显小于NSEC组（P＜0畅05）。结论：房颤患者左心耳内血栓形成与左心耳的结构以及功能改变密切相关。%Objective:To investigate the relationship between left Atrial appendage morphology and function changes of left atrial appendage( LAA) thrombosis in patients with atrial fibrillation( AF) .Methods:114 patients with AF and 54 controls were examined with real -time three -dimensional transesophageal echocardiography ( RT3D -TEE).Left atrial appendage length (LAA-L),orifice area(LAA-O),volume(LAA-V) and left atrial appendage velocity(LAA-v),left atrial volume(LA-V),left atrial appendage ejection fraction(LAA-EF) were observed and compared with those of the contral group.AF patients were divided into no spontaneous contrast subgroup(NSEC),spontaneous subgroup(SEC) and thrombus subgroup(TH).Thoses indicators were also observed between NSEC,SEC and TH subgroup.Date were calculated and analysised.Results:Values of LAA-L,LAA-0,LAA-V,LA-V were statistically higher in patients with AF than in patients with non-AF,but LAA-v, LAA-EF were Lower in patients with AF than in patients with non-AF.LAA-O,LAA-v and LA-V in TH subgroub were higher than in NSEC subgroub(P<0.05).LAA-L and LAA-EF of the three subgroups were different from each other(P<0.05), LAA-v of TH and SEC subgroups were lower than that of NSEC subgroup( P<0.05) .Conclusion:Thrombosis in AF is closely related with the morphology and function changes of LAA.