二维斑点追踪技术在尿毒症患者右心室 收缩功能评价中的应用价值

Assessment of two-dimensional speckle tracking in the evaluation of right ventricular systolic function in patients with uremia

摘要:

目的 探讨超声二维斑点追踪技术（2D-STI）在尿毒症患者的右心功能评价中的应用价值。 方法 健康对照组20 例，尿毒症患者（尿毒症组）20 例，采用双平面Simpson 法获得尿毒症患者右室舒张 期末容积（RVEDV）、右室收缩期末容积（RVESV）、右室每搏量（RVSV）、右室每分输出量（RVCO） 及右室射血分数（RVEF）。应用2D-STI 技术获得两组右室两腔及四腔切面三尖瓣瓣环相对心尖的纵向位 移曲线，得出对应的最大纵向位移及其占心尖到瓣环中点处最大化峰值位移的百分比（Dm%）进行比较分 析；应用最小二乘法分别对RVEF 与四腔心、两腔心切面瓣环连线中点处的收缩期峰值位移（FTADmid、 TTADmid），以及其占Dm 的百分比（FTADmid%、TTADmid%）做线性回归分析。结果 ①尿毒症组患者 RVEDV、RVESV、RVSV 及RVCO 高于对照组（P <0.05）；②尿毒症组患者RVEF 低于对照组（P <0.05）； ③尿毒症组患者四腔心和两腔心切面三尖瓣环右室游离壁收缩期峰值位移（TADfre）、间隔处收缩期峰值位 移（TADsep）、FTADmid 及FTADmid% 低于对照组（P <0.05），两腔心切面的前壁收缩期峰值位移（TADant）、 后壁收缩期峰值位移（TADpos）、TTADmid 及TTADmid% 低于对照组（P <0.05）；④尿毒症组RVEF 与 FTADmid、FTADmid%、TTADmid 及TTADmid% 相关系数分别为0.910、0.922、0.844 和0.841，（P <0.05）； 对照组RVEF 与FTADmid、FTADmid%、TTADmid 及TTADmid% 相关系数分别为0.834、0.842、0.783 和 0.772，（P <0.05）。结论 2D-STI 可作为尿毒症患者右心收缩功能评价的有效手段。

Abstract:

Objective To discuss application of ultrasound two-dimensional speckle tracking in the evaluation of right heart function in patients with uremia. Methods There were 20 healthy controls and 20 uremic patients. Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular output per minute (RVCO) and right ventricular ejection fraction (RVEF) in uremic patients were obtained by biplane Simpson method. Longitudinal displacement curves of tricuspid annulus relative to apex in two and four-chamber sections of right ventricle were obtained by 2D-STI technique. The corresponding maximum longitudinal displacement and its percentage of maximum peak displacement (Dm%) from the apex to the midpoint of the annulus were obtained and compared. The correlation between RVEF and peak systolic displacement (FTADmid, TTADmid) at the midpoint of four-chamber and two-chamber cardiac tangential annulus and its percentage of Dm (FTADmid, TTADmid%) was analyzed by linear regression method. Results ① The RVEDV, RVESV, RVSV and RVCO of uremic patients were higher than those of the control group (P < 0.05). ② The RVEF of uremic group was lower than that of the control group (P < 0.05) ③ The peak systolic value (TADfre), the peak systolic value (TADsep), the peak systolic value (FTADmid) at the midpoint of the annulus commissurae and the percentage of FTADmid% to Ds were all lower in the uremic group than those in the control group (P < 0.05); The peak systolic time (TADant), the peak systolic time (TADpos), the peak systolic time (TTADmid) at the midpoint of the annular junction and the percentage of TTADmid% to Ds in the uremic group were lower than those in the control group (P < 0.05). ④ The correlation coefficients between RVEF and FTADmid, FTADmid, TTADmid and TTADmid% were 0.920, 0.922, 0.844 and 0.841 in uremia and 0.837, 0.842, 0.783 and 0.772 in control group (all P < 0.05). Conclusions Two-dimensional speckle tracking imaging can be used as an effective method for evaluating right ventricular systolic function in uremic patients.