组织多普勒超声技术评价微创外科房间隔缺损封堵患者右心功能的研究

目的 研究组织多普勒超声技术评价微创外科房间隔缺损封堵患者右心功能的价值.方法 通过经胸超声心动图和多平面经食管超声心动图(MTEE)选择适合外科微创封堵治疗的房间隔缺损患者48例.其中男18例,女30例;年龄(31±16)岁.分别于术前和术后3～5 d使用sonos4500彩色多普勒超声诊断仪进行组织多普勒超声检查,经胸探头频率2.5 mHz,图像存储于光盘以便图像回放进行数据测量与分析.组织多普勒超声观察指标包括:(1)依据三尖瓣瓣环组织多普勒频谱测量收缩期主波(S波)的持续时间、收缩期运动峰值速度、舒张早期心室舒张主波和舒张晚期心房收缩波(A波)的持续时间及运动峰值速度、舒张早期心室舒张主波起点至A波终点的持续时间;(2)右室侧壁基底部(三尖瓣环处)和右室侧壁中部收缩期峰值速度、舒张早期、晚期峰值速度.结果 术后脉冲组织多普勒频谱测三尖瓣瓣环收缩期S波术后运动峰值速度(0.16±0.05)m/s比术前(0.20±0.04)m/s明显降低(P<0.05),舒张期心房收缩期A波运动峰值速度(0.12±0.03)m/s比术前(0.16±0.02)m/s均明显降低(P<0.01);术后三尖瓣收缩期主波(S波)的持续时间(231±36)ms较术前(265±24)ms明显缩短(P<0.01);术后右室侧壁基底部和中部运动速度较术前均明显降低(P<0.01).结论 组织多普勒超声技术能够准确无创评价房间隔缺损封堵术后患者右心功能的变化.

Evaluation of right ventricular function of patients with intraoperative device closure of atrial septal defect by ultrasonic Doppler tissue imaging

Objective To study the application of Doppler tissue imaging (TDI) in the assessment of right ventricular function of patients with intraoperative device closure of atrial septal defect (ASD). Methods A total of 48 ASD patients, 18 males and 30 females, were selected for intraoperative device closure. The mean age was 31±16 years old. Color Doppler echocardiographic instrument (Sonos 4500) was employed to perform the Doppler tissue imaging before and at 3-5 days after operation. The parameters included: (1) Time and peak speed of systolic motion of anterior tricuspid valve annulus (TDI-TS, TDI-PVS),early diastole motion time (TDI-TE) and late diastolic motion time (TDI-TA) and peak speed of early and late diastolic motion (TDI-PVE, TDI-PVA), interval between the early diastolic motion and late diastolic motion (TDI-TE-A); (2) Peak speed of systolic, early diastolic and late diastolic motions of the middle lateral and basic lateral walls of right ventricle. Results The TDI-PVS(0.16±0.05) m/s in post-operation was decreased than TDI-PVS(0.20±0.04) m/s in pre-operation and TDI-PVA (0.12±0.03) m/s in post-operation was decreased than TDI-PVA (0.16±0.02) m/s in pre-operation apparently (P<0.01). The TDI-TS(231±36) msec in post-operation were shorter than TDI-TS (265±24 )msec in pre-operation(P<0.01). Peak spead of Systolic, early diastolic and late diastolic motions of middle lateral and basic lateral walls of right ventricle declined post-operatively (P<0.01). Conclusion TDI is an effective method to evaluate the function of right ventricle quantitatively in patients with intraoperative device closure of ASD.