Tei指数评价房间隔缺损患者手术前后左右心室功能的研究

目的探讨应用组织多普勒（TDI）分别测量左、右心室Tei指数评价房间隔缺损（ASD）患者手术前后左、右心室功能的临床价值。方法30例健康成年人作为对照组（A组）,60例ASD患者,其中无合并肺动脉高压者30例（B组）,合并肺动脉高压者30例（C组）。应用TDI记录二、三尖瓣环的频谱图,测量相关时间间期,计算出左、右心室Tei指数。结果与A组比较,B组术前右室Tei指数增加（P〈0.05）,C组术前左、右室Tei指数均增加（P〈0.05）;与本组术前比较,B组术后左室及C组术后左、右室Tei指数均降低（P〈0.05）;结论Tei指数可以敏感地反映ASD患者手术前后左、右心室功能的变化是评价其心室整体功能的较好指标。     

多普勒超声心动图评价呼吸对我国儿童心室舒张功能的影响

本文介绍多普勒超声心动图评价呼吸对我国正常儿童左、右心室舒张功能的影响,发现呼吸仅对左心室舒张功能的部分参数有影响,但对右心室舒张功能的多项参数影响特别明显。提示在应用多普勒技术估价儿童心室舒张功能时要考虑到呼吸时相的标准化,应分别测取吸气末、呼气末的心室舒张充盈频谱参数。另外,本文测定的心室舒张功能参数亦可作为我国儿科临床评价心室舒张功能的参考资料。     

超声心动图评价右心功能的应用

超声心动图是临床评价右心功能最常用的方法,现就近年来常用的关于评价右心功能的各种超声技术进行综述。     

多普勒超声对肺心病患者左右心室舒张功能的评价

本文对 2 1例肺心病患者左右心室舒张功能进行观察分析。1　资料与方法1.1　对象2 1例肺心病均为我院住院患者 ,符合全国第二次肺心病专业会议制定的慢性肺心病诊断标准 ,并将合并冠心病、高血压、心肌炎、糖尿病、高血脂及甲状腺功能亢进等患者剔除 ,其中男 17例 ,女 4例 ,年龄 47～ 64岁 ,平均 5 9± 9岁。健康对照组为排除肺部疾病及原发和继发心脏疾病者 ,共 2 5例 ,男 2 0例 ,女 5例 ,年龄 5 0～ 65岁 ( 5 8± 8岁 )。2 .2　方法使用 HP- 770 3 0 A型彩色多普勒显像仪 ,探头频率2 .5 MHz,检查前停服解痉平喘、扩血管等有影响的药物。…     

超声心动图评价右室收缩功能

超声心动图评价右室收缩功能昆明市延安医院云南省昆明心胸外科研究中心陈明综述陈圣邦审校正确评估右室收缩功能对了解心脏的生理及病理生理变化有重要意义。随着超声心动图技术的发展，人们已能应用超声手段估测右室功能，为心血管临床提供有关右室泵血状况的资料。曾有...     

64排容积CT和超声心动图评价右心室功能的比较研究

目的：以超声心动图为标准,探讨64排容积CT（VCT）和超声心动图对右心室功能各评价指标的相关性,评价64排VCT测量右心室功能的准确性及可行性。方法：对36例64排VCT冠状动脉造影患者,使用专业心脏软件测量右心室功能,并与超声心动图所得右心室功能各项指标相比较,包括右室舒张末期容积（RVEDV）、收缩末期容积（RVESV）、每搏量（RVSV）及射血分数（RVEF）等心功能指标。结果：64排VCT和超声心动图测定的右心室功能指标值分别为RVEDV[125.3±20.5）ml比（118.0±19.4）ml],RVESV[（58.1±23.4）ml比（55.2±21.6）ml],RVSV[（71.2±15.2）ml比（74.8±16.3）ml],RVEF[（51.8±6.6）%比（58.4±8.5）%],P均〉0.05,差异无显著性;两者相关性较高,r=0.617～0.813。结论：64排容积CT对右心室功能定量评价准确可靠。一次64排容积CT冠状动脉成像可以同时评估冠状动脉狭窄情况及右心室功能参数。     

超声心动图评价左心室功能

1 左心室收缩功能 心腔的测量和左心室收缩功能的测定是超声心动图检查的重要组成部分.尽管一些新的超声技术如组织多普勒成像、应变成像、三维超声心动图(3D)的应用使得心脏功能的测定更加定量化和精确,二维超声心动图(2D)仍是目前心腔定量测量和左心室(LV)收缩功能测定的主要方法.同时二维超声心动图可以显示心内膜边界以及室壁增厚情况,从而判断心室整体和局部的收缩功能.     

多普勒超声心动图对室性心动过速心室收缩效果的评价

用健康犬以分级递增刺激方式建立不同频率的室性心动过速模型，通过同步记录左室和主动脉压力曲线以及主动脉血流频谱的方法，对室速发作时心室收缩是否有效进行研究，结果证明，记录主动脉血流频谱是判断室速发作时心室收缩效果的快速，无创、简便、可靠的手段。     

Tei指数评价系统性红斑狼疮患者左右心室功能的研究

目的：探讨应用组织多普勒（TDI）分别测量左、右心室Tei指数评价系统性红斑狼疮（SLE）患者左、右心室功能的临床价值。方法：20例健康成年人作为健康对照组（A组）,40例SLE患者,其中合并轻度肺动脉高压者20例作为B组,合并中度以上肺动脉高压者20例作为C组。应用TDI记录二、三尖瓣环的频谱图,测量相关时间间期,计算出左、右心室Tei指数。结果：①与A组比较,B、c两组右室等容舒张时间[IRT,（46．95±14．42）ms比（69．65±24．57）ms比（94．30±23．56）ms]、等容收缩时间[ICT,（41．70±12.33）ms比（55．60±15．14）ms比（79．35±18．84）ms]明显延长,射血时间[ET,（297．95±26．57）ms比（273．35±34．46）ms比（233．00±30．84）ms]明显缩短,右室Tei值[RV—Tei,（0．30±0．10）比（0．48±0．20）比（0．78±0．27）]明显增大（P〈0．05或〈0．01）;与B组比较,C组右室IRT、ICT显著延长,ET显著缩短,Tei值显著增大（P〈0．05）;②与A组及B组相比,C组左室IRT[（73．95±14．22）ms比（76．75±16．36）ms比（95．00±15．30）ms]显著延长,ET[（288．05±26．55）ms比（274．85±33．14）ms比（254．25±31．08）ms3显著缩短,Tei指数[（0．44±0．09）比（0．49±0．14）比（0．61±0．14）]显著增加（P〈0．05或〈0．01）,ICT差异无显著性;B组与A组相比,左室IRT、ICT、ET及Tei值之间的差异均无显著性。结论：①Tel指数是评价系统性红斑狼疮患者心室整体功能敏感而又准确的多普勒超声指标;②右室压力负荷增加对左室功能有明显影响。     

系统性硬化病患者的食物胃排空和胃内分布

为探讨无消化道症状的系统性硬化病（ＳＳ）患者的胃排空功能，以双核素标记试餐及单光子发射计算机断层摄影（ＳＰＥＣＴ）技术检测了１１例无消化道症状的ＳＳ患者之液体与固体食物的胃排空和胃内分布，对照组为１７例健康志愿者。结果：ＳＳ组液体和固体食物的近端胃排空和全胃排空均慢于对照组（Ｐ值＜０．０５）；液体和固体食物的近端胃半排空时间均与它们的全胃半排空时间之间存在正相关（Ｐ值分别＜０．０２和０．０１）。９例患者固体半排空时间延迟，其中８例伴液体排空障碍。在食物的排空过程中，远端胃内的活性变化与对照组的差异无显著性。结果提示：尽管缺乏胃轻瘫的主观症状，但该组患者也存在明显的胃排空障碍，这可能与其神经功能紊乱所致的近端胃的紧张性收缩障碍有关。     

组织多普勒联合Tei指数评价右室梗死患者右心功能

目的探讨应用多普勒组织成像(DTI)技术及Tei指数评价右室梗死患者的右心功能。方法急性下壁心肌梗死51例,于心尖四腔观切面以DTI速度模式录取三尖瓣游离壁侧瓣环、室间隔侧瓣环和游离壁中段收缩期、舒张早、晚期峰值运动速度(Sm、Em、Am)及Em/Am;以脉冲多普勒记录三尖瓣关闭至再次开放间期,并于胸骨旁短轴切面记录射血时间,计算右心Tei指数。结果右室心肌梗死组于三尖瓣游离壁侧瓣环及右室游离壁中部Sm、Em较无右室心肌梗死及正常对照组明显减低[游离壁侧瓣环Sm(70±20)cm/s比(87±19)cm/s和(106±21)cm/s,P<001;游离壁侧瓣环Em(63±19)cm/s比(79±18)cm/s和(96±19)cm/s;P<001;游离壁中段Sm(64±19)cm/s比(80±19)cm/s和(94±20)cm/s,P<005;游离壁中段Em(61±20)cm/s比(76±20)cm/s和(92±23)cm/s;P<005];右心Tei指数亦较其他两组普遍增高(065±019比040±015和026±010;P<001)。结论DTI技术检测三尖瓣游离壁侧瓣环及右室游离壁中段运动速度及右心Tei指数可无创、迅速评价右室心肌梗死患者右心室功能。     

系统性硬化病患者发生胃食管反流症状的病例对照研究

目的 探讨中国人群系统性硬化病(SSc)患者胃食管反流症状(GER)的发生率及其与肺动脉高压(PAH)的相关性.方法 对北京协和医院风湿免疫科205例SSc患者进行研究;GER定义为轻中度烧心和(或)反酸每周大于2d,重度烧心和(或)反酸每周＞1 d;评价患者的临床表现、实验室检查及6min步行距离(6MWD)、心脏超声、肺功能和改良Rodnan皮肤评分(mRSS).应用x2检验和Fisher确切概率法、t检验对资料进行分析;用Logistic回归模型进行危险因素的分析.结果 在205例SSc患者中43.9％(90/115)合并有GER;合并GER的患者雷诺现象(98.9％与92.2％)、指端溃疡(56.7％与51.3％)、PAH(23.3％与9.6％)和其他消化系统表现的发生率明显高于不合并GER者(non-GER,P＜0.05);在GER组和non-GER组之间各种自身抗体的阳性率差异都无统计学意义;心脏超声显示GER组的左心室射血分数(LVEF)下降[(67±10)％与(70±5)％];纽约心脏病学会(NYHA)分级显示GER组心功能下降(P=0.015);肺功能检查显示GER组用力肺活量占预计值百分比(FVC％),第1秒用力呼气量占预计值百分比(FEV1％)和肺CO弥散量占预计值百分比(DLCO％)较non-GER组下降,FVC％/DLCO％较non-GER组升高(P＜0.05);GER是SSc患者PAH发生的独立危险因素(P=0.047,OR=3.41).结论 GER是SSc患者常见的并发症,其发病与血管病变有关,合并GER的SSc患者应接受PAH的筛查.     

Non-invasive assessment of systolic left ventricular function in systemic sclerosis

Systemic sclerosis is a multisystemic disorder, also affecting the heart. To evaluate its influence on systolic left ventricular (LV) function, we investigated 30 consecutive patients (age 54.5 +/- 2.4 years, 15 men and 15 women) and 48 controls matched for age and sex. All subjects were investigated by phonocardiography, pulse curve recordings, M-mode echocardiography, and by pulsed and continuous wave Doppler. Heart rate, blood pressure and peripheral resistance did not differ, but patients weighed less than controls (P less than 0.01). Systolic time intervals indicated systolic impairment, with an increased pre-ejection period to LV ejection time (LVET) ratio (0.37 +/- 0.02 vs 0.30 +/- 0.01 P less than 0.001), and also an increased isovolumic contraction time to LVET ratio (0.17 +/- 0.02 vs 0.12 +/- 0.01, P less than 0.02). The latter difference remained when LVET was adjusted for heart rate. Echocardiographic E-point to septal separation was increased in patients (8.3 +/- 1.3 vs 4.8 +/- 0.3 mm, P = 0.001), also after adjustment for LV dimension (P = 0.0001), while septal fractional thickening was decreased (P less than 0.01). End systolic wall stress (P = 0.0002) and stress to volume ratio (P = 0.03) were lower in systemic sclerosis. Peak LV emptying rate was also lower in the patient group when measured by echocardiography (P = 0.03). There was no difference between groups regarding LV dimensions, fractional shortening or mean velocity of circumferential fibre shortening. While aortic Doppler peak emptying rate did not differ between groups, it occurred later in systole in the patient group (P less than 0.01) as did peak velocity (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Impairment of left ventricular function in systemic lupus erythematosus evaluated by measuring myocardial performance index with tissue Doppler echocardiography

In 44 patients affected by systemic lupus erythematosus (SLE) without any clinical signs of heart disease (group I) the myocardial performance index (MPI) was calculated to investigate left ventricular function. The index, as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), was measured by tissue Doppler echocardiography (TDE). Results achieved show a prolonged MPI with respect to the values recorded in healthy controls (group II). Its prolongation is due to a significant increase of IRT, whereas ICT and ET were within the normal limits. In patients with SLE without an evident cardiac engagement, this outcome seems to depend on a prevalent diastolic left ventricular dysfunction, perhaps due to a subclinical myocarditis. TDE is more precise than the conventional Doppler method in evaluating MPI and single time intervals, because their measurements are accomplished in concomitance of left ventricular wall motion rather than the flow movement.     

组织多普勒技术评估血栓抽吸治疗对急性下壁心肌梗死患者右室功能的影响

目的 探讨组织多普勒(TDI)技术评估血栓抽吸治疗对急性下壁心肌梗死(AIMI)患者右室功能的影响.方法 将46例AIMI患者随机分为两组,对照组27例行急诊经皮冠脉介入(PCI)治疗,观察组19例行PCI+血栓抽吸治疗.两组均于PCI后1周行超声心动图检查,在胸骨旁长轴用M型超声检测左室舒张末内径(LVEDD)、左房前后径(LAD)、右室舒张末内径(RVEDD)、左室射血分数(LVEF);在标准心尖四腔心切面转换为TDI频谱多普勒形式,检测三尖瓣环收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、心房收缩期峰值运动速度(Am)及Em/Am比值;并计算右室Tei指数.结果 与对照组比较,观察组三尖瓣环的Sm、Em、Am及Em/Am比值升高,右室Tei指数下降(P均＜0.05),LVEDD、LAD、RVEDD、LVEF均无明显变化(P均＞0.05).结论 TDI技术能检测到AIMI患者的右室功能变化,血栓抽吸治疗可改善其右室功能.     

Non-invasive assessment of left ventricular diastolic function in patients with systemic sclerosis

To evaluate the extent of left ventricular (LV) diastolic impairment in systemic sclerosis, we examined 30 consecutive patients (15 men and 15 women) with this condition, and compared the findings with the data for 48 age- and sex-matched randomly sampled controls. All patients were investigated by phonocardiography, pulse curve recording, and M-mode echocardiography. Twenty-three of 30 (77%) patients had LV hypertrophy and/or diastolic impairment. Interventricular septum (P = 0.0001), LV posterior wall (P less than 0.05), and the wall thickness to cavity dimension ratio (P less than 0.001) were increased in patients compared to controls, as was LV mass index (P less than 0.002). Five patients had asymmetric septal hypertrophy. LV end-diastolic dimension did not differ between groups. LV distensibility was impaired, as judged from apexcardiographic a/H ratio (P less than 0.05) and from an increased left atrial index (P less than 0.005). LV early filling was impaired, with a reduced left atrial emptying index (P = 0.0001), and a reduced rate of dimension increase in digitized M-mode (P less than 0.02). We found no evidence of impaired LV relaxation. Blood pressure did not differ between patients and controls. With longer duration of the disease, left atrial dimension appeared to increase (r = 0.42, P less than 0.05), while other variables were not related to disease duration. The impaired LV filling was not secondary to systolic dysfunction. We conclude that systemic sclerosis patients have an increased LV wall thickness, with impaired early filling properties and LV distensibility.     

多普勒超声心动图评价再血管化治疗对心肌梗死患者心功能的影响

目的　观察再血管化治疗对心肌梗死患者左心室重塑和心功能的影响。方法　选择2 0 0例冠心病心肌梗死患者 ,分为再血管化组和单纯药物治疗组。用超声心动图观察心腔径、收缩及舒张功能。结果　再血管化治疗较药物治疗者心腔径指标明显缩小 ,舒张末容积 (EDV) ,舒张末容积指数 (EDVI) ,收缩末容积 (ESV) ,收缩末容积指数 (ESVI)明显缩小 ,射血分数 (EF) ,短轴缩短率 (FS)显著增加 (P <0 0 5 )。结论　再血管化治疗比单纯药物治疗能更好地减轻心肌梗死患者左心室重塑 ,改善收缩功能。     

Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue Doppler.

AIMS: This study analyses right ventricular longitudinal function in arterial systemic hypertension by pulsed tissue Doppler. METHODS AND RESULTS: Thirty normotensives and 30 hypertensives, free of cardiac drugs, underwent standard Doppler echocardiography and pulsed tissue Doppler of right ventricular lateral tricuspid annulus and left ventricular lateral mitral annulus. By tissue Doppler, systolic and diastolic measurements were obtained. Hypertensives had higher left ventricular mass and impaired Doppler diastolic indexes, without changes of global systolic function. Tissue Doppler showed reduction of right ventricular E/A ratio and prolongation of relaxation time in comparison with controls (both P<0.00001). In the overall population, the length of tissue Doppler derived right ventricular relaxation time was positively related to right ventricular anterior wall thickness while right ventricular E/A ratio was positively related to E/A ratio of left ventricular mitral annulus (both P<0.00001). These relations remained significant even after adjusting for clinical and echocardiographic confounders by separate multivariate models. CONCLUSIONS: Arterial systemic hypertension is associated to right ventricular longitudinal diastolic dysfunction. This dysfunction involves the prolongation of active relaxation, which is independently associated with the degree of right ventricular hypertrophy and the impairment of passive wall properties, which is mainly due to ventricular interaction occurring under left ventricular pressure overload conditions.     

系统性硬化病患者指溃疡的关联因素分析:来自中国欧洲抗风湿病联盟硬皮病试验研究组数据库的资料

目的 了解出现指溃疡的系统性硬化病( SSc)患者的临床特点及危险因素,以便早期预防及治疗,提高生活质量.方法 北京协和医院欧洲抗风湿病联盟硬皮病试验研究组数据库中,在2009年2月至2010年8月间前瞻性地收集SSc患者共166例,均满足1980年美国风湿病学会SSc分类(诊断)标准.对出现指溃疡的患者的临床表现、实验室检查与未出现者进行对比分析.计量资料采用-x±s表示,采用t检验,计数资料采用X2检验进行对比;采用Logistic回归进行危险因素分析.结果 ①166例患者中,共49例患者(29.5％)出现指溃疡,出现指溃疡的年龄(36±12)岁,全部患者存在雷诺现象.②有指溃疡患者的年龄(40±12)岁,雷诺现象发病年龄(33±12)岁,从雷诺现象到出现其他临床表现的时间(18±15)个月,与无指溃疡的SSc患者[分别为(46±12)岁,P=O.005;(39±13)岁,P=0.005;(115±307)个月,P=0.002]相比差异均有统计学意义.③与没有指溃疡的患者相比,有指溃疡的患者男性比例升高,以弥漫型SSc更常见,食管受累多(P＜0.05).结论 SSc患者中指溃疡并不少见,尤其在男性以及弥漫型SSc患者中更常见,有指溃疡者,其出现雷诺现象的年龄偏小,该组患者更易合并食管受累.     

系统性硬化病合并原发性胆汁性肝硬化的临床分析及文献复习

目的 探讨系统性硬化病(SSc)合并原发性胆汁性肝硬化(PBC)患者的临床特征,提高对此重叠综合征的认识.方法 收集北京协和医院2005年4月至20l0年4月确诊为SSc合并PBC的病例资料,对符合条件的9例患者的临床表现、实验室检查和组织病理检查进行分析.同时进行文献复习,与国外资料进行比较.结果 ①9例患者中男性1例,女性8例,平均年龄(54±8)岁;以SSc起病者7例,以PBC起病者2例,二病发生间隔1～8年、平均(4.3±2.3)年.②弥漫型SSc(dcSSc)仅1例,而局限型SSc(lcSSc)8例(完全型CREST综合征2例,不完全型5例),8例有雷诺现象和食管运动功能障碍,并均以雷诺现象起病.有PBC临床表现者5例,亚临床型4例,胆管酶升高8例,2例行肝穿刺病理检查为PBC的Ⅰ和Ⅱ期.③抗核抗体均阳性,抗着丝点抗体(ACA)阳性8例,抗线粒体抗体(AMA)阳性9例,AMAM2阳性8例.④早期给予糖皮质激素和熊去氧胆酸治疗有效,3例因肺间质纤维化、肺动脉高压和肝硬化疗效欠佳.结论 SSc可以合并PBC,以lcSSc、尤其是CREST综合征多见,筛查ACA、AMA、AMA-M2可早期识别SSc合并PBC,早期干预有助改善预后.