实时三维超声联合右心声学造影评价肺源性心脏病患者右心室收缩功能的价值

摘要

目的应用实时三维超声心动图探讨肺源性心脏病患者右心室收缩功能的价值，比较右心造影对测值的影响。方法选择肺源性心脏病代偿组、失代偿组、正常对照组各20例分别进行造影前、后实时三维超声的采集成像，计算右心室舒张末容积（RVEDV）、右心室每博输出量（RVSV）和右心室射血分数（RVEF），并根据心内膜是否清晰可辨分为心内膜边界清晰者、心内膜边界欠清晰者，比较两者三维超声参数的组间差异。结果代偿组、失代偿组RVEDV较对照组均明显增加，RVEF值减低（均P＜0.01），代偿组与对照组RVSV差异无统计学意义（P＞0.05），但失代偿组RVSV与代偿组、对照组差异有统计学意义（P＜0.05）；失代偿组RVEDV较代偿组明显增大，RVEF明显减低（均P＜0.01）。心内膜边界欠清晰者造影后较造影前RVEDV、RVEF差异均有统计学意义（均P＜0.05）。结论实时三维超声能够客观地反映肺源性心脏病代偿期与失代偿期右心室收缩功能的变化，右心声学造影改善了心内膜边界的可识别性，提高了右心室收缩功能测值的可靠性。%　　Objective To assess the application of real-time three-dimensional echocardiography (RT3DE) combined with right heart contrast echocardiography in evaluation of right ventricular systolic function in patients with pulmonary heart dis-ease. Methods 40 patients with pulmonary heart disease, including 20 cases with compensated right heart function and 20 cas-es with decompensated heart function, were enrol ed in the study;20 healthy subjects served as controls. Al subjects underwent real-time three-dimensional echocardiography before and after right heart contrast echocardiography. The parameters on RT3DE were col ected and right ventricular end-diastolic volume(RVEDV), stroke volume(RVSV) and ejection fraction(RVEF) were calcu-lated. According to the legibility endocardium, patients were furtherly divided into the endocardial border clear group and endo-cardial border unclear group, and the differences three-dimensional ultrasound parameters were compared between two groups. Results RVEDV in patients with pulmonary heart disease were increased and RVEF decreased significantly compared to control group(P<0.01). There were no differences in RVSV value between compensated patients and controls(P>0.05), but RVSV in de-compensated patients was significantly lower than that in compensated patients and healthy controls(P<0.05). RVEDV in decom-pensated patients was significantly higher and RVEF was lower than those in compensated patients(P<0.01). The RVEDV and RVEF values of endocardial boundary unclear group were significantly changed before and after contrast echocardiography (P<0.01). Conclusion Real-time three-dimensional echocardiography can objectively reflect the changes in pulmonary heart dis-ease with compensated and decompensated right ventricular systolic function. Right heart contrast echocardiography improves the legibility of endocardial border and enhances the reliability of the measurement of right ventricular systolic function.