三维超声心动图对肺心病患者心功能的研究

三维超声心动图（３ＤＥ）检测心功能参数是根据心脏腔的实际形状而无需假设几何模型。目前３ＤＥ局限于左心功能的研究，时右心室研究极少，国内尚无报告。慢性肺原性心脏病是首先累及右心功能的常见病之一，故而，本文用３ＤＥ研究慢性肺心病患者的右心功能，一是探索３ＤＥ应用于右心室的临床价值，二是对肺心病患者的心功能做个初步的观察。本文首先用３ＤＥ计算肺心病患者的ＲＶＥＦ并与ＳＰＥＣＴ进行核素心功能测定的ＲＶＥＦ比较，两法相关较好（γ＝０．８６）。在此基础上，测定以下几项功能参数：（１）用３ＤＥ检测肺心病患者、正常人的右室容量及ＲＶＥＦ，与正常人相比，肺心病患者的ＥＳＶ明显增大，ＳＶ及ＲＶＥＦ降低；（２）用３ＤＥ检测右室游离壁体积，肺心病患者的该指标较正常人增大；（３）用３ＤＥ检测右室节段收缩率，结果表明肺心病患者的右室收缩功能减低为整个心肌收缩力降低而非节段性心肌功能减弱；（４）用３ＤＥ检测左室容量及ＬＶＥＦ，肺心病患者的ＥＤＶ、ＳＶ及ＬＶＥＦ均明显低于正常组。根据上述结果，本文认为３ＤＥ应用于右心室功能测定是目前比较直接、可靠而实用的床边检查方法。

Assessment of Cardiac Function in Chronic Cor Pulmonale by 3-D Echocardiogram

Estimation of cardiac funetion with 3-D echocardiogram is based on the real shape of cardiac chamber without the assumption of geometric model.Till now.most of 3-D e-chocardiogram studies concerned on the left ventricular function,few on the right ventricular func-tion. In this article,chronic cor pulmonale(CCP)was valued by 3-D echocardiogram in the assess-ment of right ventricular function as it is a common disease of the P.R.Comparing the results of right ventricular ejection fraction(RVEF)assessed by 3-D echocardiogram and that by SPECT,a correlation rate of r=0.86 was shown.Through 3-D echocardiogram,the foolowing data yield:(1)The mean right ventricular ESV was enlarged,while the mean right ventricular SV and EF were decreased in CCP as compared with normals(P<0.001).(2) The mean right ventricular free wall volume of CCP was greater than that of normals (P <0.001).(3)The decrease of right ventricular contraction was global rather than segmental.(4) The EDV, SV and EF of left ventricle were decreased in CCP as compared with normals(P<0. 01).The authors consider that 3-D echocardiogram is a reliable and practical method in the estima-tion of right ventricular function and could be used at the bedside.