容量负荷变化对组织多普勒评价左心室舒张功能的影响

目的探讨容量负荷变化对组织多普勒成像技术（TDI）检测左心室舒张功能参数的影响。方法左心室收缩功能正常的88例肾功能衰竭患者按透析量分为3组：透析量〈2000ml（组1）33例,透析量为2000ml～3000ml（组2）30例,透析量〉3000ml（组3）25例,运用脉冲多普勒测定3组患者舒张期二尖瓣口血流频谱（E、A）,脉冲型组织多普勒技术（PW-TDI）测量左室二尖瓣环四个位点（间隔、侧壁、前壁、下壁）的平均收缩期峰值速度（Sa）、舒张早期峰值速度（Ea）和舒张晚期峰值速度（Aa）。对3组透析前、后各值对比分析。结果组1的TDI各参数透析后无显著改变（P〉0.05）,组2、组3患者透析后除Sa外各参数值显著下降（P〈0.05）。结论 TDI技术评价尿毒症透析患者的左心室舒张功能时,当透析量较少时其结果较可靠,但随透析量增大则可能受容量负荷的影响。二尖瓣环收缩期运动速度Sa对容量负荷的变化无依赖性。

Effects of the Change of Preload to Left Ventricular Diastolic Function by Tissue Doppler Imaging

Objective To explore the effects of the change of preload to the left ventricular diastic function by tissue Doppler imaging（ TDI） . Methods Eighty-eight patients with uremia receiving regular hemodialysis（ H/D） were separated by the amount of body fluid removed during H/D procedure： group 1： 2 000 ml,group 2： 2 000 ～ 3 000 ml,group 3： 3 000 ml. The diastic trans-mitral velocity（ E,A） , the mean of mitral annulus systolic peak velocities,early diastolic peak velocities and later diastolic peak velocities of mitral annulus （ Mean Sa,Mean Ea,Mean Aa） were obtained immediately before and after H/ D. Results For group 1,the change of TDI parameters showed insignificant change（ P 0. 05） ; for group 2 and group 3,the change of all diastolic parameters showed stastistically significant difference except mean Sa（ P 0. 05） . Conclusions In uremic patients with normal left ventricular systolic function,when the amount removed during H/D is less than 2 000 ml ,the parameters of TDI is steady,when the amount removed during H/D is more than 2 000 ml ,diastolic phase mitral annulus Doppler tissue velocities are not totally independent preloadedly. For systolic phase mitral annulus Doppler tissue velocity index（ Sa） ,it is independent preloadedly.