超声心动图对心脏移植术后右心形态学改变的观察及其机制分析

目的：观察心脏移植术后右心形态改变，并对其机制进行分析。方法：研究对象共分为3组；心脏移植组(A组)、肝脏移植组(B组)及正常对照组(C组)，A、B两组按术后激素用量大小分为第一及第二阶段，测量不同阶段右室舒张末期内径(RVEDD)、右室舒张末期容积(RVEDV)等指标观察右心形态及功能变化，同时观察三尖瓣返流情况并推测肺动脉压，将结果与正常组相比较，并进行统计学分析。持续观察1年。结果：A组患者第一阶段右心明显扩大，与正常组对照差别有显著性，右心扩大程度与手术后激素用量及补液量有关，B组患者术后第一阶段右心轻微增大，与正常组对照差别无显著性，第二阶段右心未见扩大。A组患者手术后三尖瓣返流持续存在，与肺动脉压无关。结论：心脏移植术后右心明显扩大，与右心容量负荷增加导致的钠水潴留有关，钠水潴留可能与心脏的去神经作用导致异常的心肾反射有关。

Echocardiographic Observation of Right Heart Morphological Alteration and Analysis of the Mechanism After Heart Transplantation

Objective:To observe the morphologica l alteration of right heart and analyse the mechanism after heart tansplantation Methods:All objects were divided into 3 groups:group A:he art transplantation group; group B:hepartransplantation group; group C:normal co ntrol group Two of these three groups( A and B) were divided into 2 stages ac cording to the variant dosages of steriod hormone adminastrations The parameter s as right ventricular end diastolic diameter(RVEDD),its volume(RVEDV) and pulmo nary pressure etc were determined and compared with those of the control group i n two stages within one year Results:The degree of right heart dilatation was much higher in group A than that in group B and the differ ence was significient The dilatation extents related to the dosages of steriod hormone and fluid infusion obviously The right heart size in group B was incre ased slightly in the first stage,but no enlargement was found during the second stage There was persistent tricuspid regurgitation in group A after heart trans plantation without relationship to pulmonary pressure Conclusions:The right heart which was obviously enlarged after heart transplantation probably related to load incresement due to sodium a nd fluid retention which was caused by abnormal cardiorenal neuroendocrine refle xes secondary to cardiac denervation