超声心动图评估急性脑损伤患者的左心室功能

目的应用超声心动图对急性脑损伤患者的左心室功能状态进行评估。 方法回顾性选取2015年1月至2015年10月北京朝阳急诊抢救中心颅脑损伤中心重症监护室收治的急性颅脑损伤患者85例，同时随机选取北京朝阳急诊抢救中心矫形骨科和创伤骨科行外周创伤外科手术或肢体矫形手术的患者74例作为对照组，所有患者均于入院后行常规心脏超声心动图检查。对比分析2组患者的左心室前后径（LVD）、左心室容积（LVV）、左心室射血分数（LVEF）以及二尖瓣血流频谱E峰和A峰比值（E/A），并对85例急性脑损伤患者的心功能异常情况进行分析。 结果急性脑损伤组的LVD为（47.8±4.3）mm、LVV为（107.1±26.4）ml，均大于对照组的（45.8±3.3）mm、（98.5±18.8）ml，且差异均有统计学意义（t=2.57、2.33，P=0.02、0.02）。急性脑损伤组的LVEF为（54.7±8.2）%，较对照组的（60.9±6.38）%减低，且差异有统计学意义（t=-5.26，P=0.00）。2组间的E/A比较，差异无统计学意义（P>0.05）。急性脑损伤组85例患者中，7例（7/85，8.2%）左心室整体收缩功能减低（LVEF<50%），28例（28/85，32.9%）出现节段性室壁运动异常，2例（2/85，2.4%）表现为左心室整体球形扩大，收缩运动明显减弱。 结论急性脑损伤患者并发左心室收缩功能异常的比例较高，应引起临床医师的重视，应用超声心动图对其进行评估可为临床诊疗方案的实施提供依据。

Comparative assessment of left ventricular function in patients with acute brain injury

ObjectiveTo evaluate the function of left ventricle in patients with acute brain injury. MethodsEighty-five patients with acute brain injury under the age of 50 were assessed by echocardiography in the Intensive Care Unit (ICU), Craniocerebral Trauma Center, Beijing Chaoyang Emergency Medical Center from January 2015to October 2015. Assessed parameters of heart function included left ventricular diameter (LVD), left ventricular volume (LVV), left ventricular ejection fraction (LVEF), and mitral valve E/A ratio. Seventy-four patients under the age of 50 who would undergo surgery for peripheral trauma or limb orthopedic operation at the same hospital were included as a control group. ResultsLVD and LVV in the acute brain injury group were significantly higher than those of the control group [LVD: (47.8±4.3) mm vs (45.8±3.3) mm, t=2.57, P=0.02; LVV: (107.1±26.4) mL vs (98.5±18.8) mL, t=2.33, P=0.02]. LVEF in the acute brain injury group was significantly lower than that of the control group [(54.7±8.2)% vs (60.9±6.38)%, t=-5.26, P=0.00]. E/A rate did not differ significantly between the two groups (P>0.05). In the acute brain injury group, 7 (7/85, 8.2%) cases had reduced (LVEF<50%), 28 (28/85, 32.9%) cases had regional wall motion abnormalities, and 2 (2/85, 2.4%) cases presented with ventricular global ballooning and hypokinesis (atypical Takotsubo cardiomyopathy). ConclusionCardiac dysfunction after acute brain injury is not rare. Attention should be paid to this serious issue in clinical practice, and assessment of left ventricular function in these patients by echocardiography can provide valuable information for clinical management.