本文選題：左室射血分數(shù)正常的心力衰竭 + 無癥狀左室舒張功能障礙　； 參考：《吉林大學》2014年碩士論文

【摘要】：目的：本研究應用二維斑點追蹤技術(2DSTI)，觀察、分析左室射血分數(shù)正常的心力衰竭(HFNEF)患者和無癥狀的左室舒張功能障礙(LVDD)患者左心室長軸方向的縱向應變、應變率及心肌運動的同步性等指標，同時觀察2DSTI測得的指標和血漿NT-proBNP水平之間的相關性。旨在探討2DSTI在HFNEF患者診斷和評價其左室舒張、收縮功能及心肌運動同步性中的應用價值。 方法：實驗組HFNEF23例，對照組無癥狀的LVDD17例，記錄其身高、體重等基本信息及血漿NT-proBNP水平，比較之間的差異。 同時行常規(guī)超聲心動圖檢查記錄左房內(nèi)徑、左室舒張末期內(nèi)徑、左室射血分數(shù)、二尖瓣血流流速、二尖瓣環(huán)運動速度等指標。采集心尖四腔、三腔、二腔心切面動態(tài)二維圖像導入Qlab8.1軟件進行脫機處理，分析后獲得四腔、三腔、二腔心三個切面及總體左室長軸縱向應變及應變率隨時間的變化曲線，記錄左室整體及各切面的收縮期期縱向應變峰值(LSs)，舒張早期縱向應變率峰值(LSRe)，16節(jié)段、12節(jié)段、6節(jié)段收縮應變達峰時間的標準差(Ts-SD)，任意對應兩節(jié)段的收縮應變達峰時間的最長時間間隔(Ts-diff)。 用SPSS軟件分析2DSTI獲得的應變及應變率、達峰時間的標準差及對應節(jié)段的最長時間間隔與NT-proBNP的相關性；比較實驗組和對照組2DSTI獲得的各指標之間的差異。 結果：1、HFNEF組血漿NT-proBNP水平明顯高于無癥狀的LVDD組(p0.05)；LogNT-proBNP與左室整體舒張早期縱向應變率峰值(GLSRe)、16節(jié)段收縮應變達峰時間的標準差(Ts-SD16)顯著相關。 2、HFNEF組和無癥狀的LVDD組LVEF無明顯差異(p0.05)；HFNEF組整體及兩腔心切面收縮期縱向應變峰值(GLSs、02-LSs)明顯減低，差異有統(tǒng)計學意義(p0.05)；左室整體及兩腔、三腔、四腔心切面舒張早期縱向應變率峰值(GLSRe、02-LSRe、03-LSRe、04-LSRe)明顯減低，差異有統(tǒng)計學意義(p0.05)。 3、HFNEF組較無癥狀的LVDD組16節(jié)段、12節(jié)段的Ts-SD增大，Ts-diff延長，差異有統(tǒng)計學意義(p0.05)。Ts-SD、Ts-diff與整體收縮期縱向應變峰值(GLSs)、整體舒張早期縱向應變率峰值(GLSRe)顯著相關。 結論：1.2DSTI測得的部分指標與血漿NT-proBNP水平顯著相關，應變和應變率是評價HFNEF的良好指標。2.對于HFNEF患者，2DSTI對左室收縮功能的評價優(yōu)于LVEF，，能夠早期發(fā)現(xiàn)左室收縮功能的改變；2DSTI對舒張功能的改變有較高的敏感性，可評價其受損程度，同時能夠測定心肌運動的同步性，為舒張功能障礙的分級及HFNEF的診斷和治療提供新的思路。
[Abstract]:Objective: to observe and analyze the longitudinal strain of left ventricular long axis in patients with heart failure with normal left ventricular ejection fraction (LVNEF) and asymptomatic left ventricular diastolic dysfunction (LVDDD). Strain rate and synchronism of myocardial movement were also observed. The correlation between 2DSTI and plasma NT-proBNP level was observed. To investigate the value of 2DSTI in the diagnosis and evaluation of left ventricular diastolic, systolic function and myocardial synchronism in patients with HFNEF. Methods: the patients with HFNEF23 in the experimental group and those with asymptomatic LVDD17 in the control group were compared with each other in terms of their height, weight and plasma NT-proBNP level. At the same time, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, mitral flow velocity and mitral annular velocity were recorded by conventional echocardiography. The dynamic 2D images of apical four cavities, three cavities and two cavities were imported into Qlab8.1 software for offline processing. The curves of longitudinal strain and strain rate with time of four cavities, three cavities, two cavities, three sections and the whole left ventricular long axis were obtained. The peak value of longitudinal strain during systolic period and the peak value of early diastolic longitudinal strain rate in left ventricular whole and each section were recorded. The peak value of early diastolic longitudinal strain rate and the standard deviation of peak time of peak systolic strain of 12 segments and 6 segments of 16 segments and 12 segments of left ventricle were recorded, and the peak time of contraction strain of two segments was arbitrarily corresponding to the peak time of contraction strain. The longest time interval between them is Ts-diffen. The strain and strain rate obtained by 2DSTI, the standard deviation of peak time and the correlation between the longest interval of corresponding segment and NT-proBNP were analyzed by SPSS software, and the differences between the indexes obtained by 2DSTI in experimental group and control group were compared. Results compared with asymptomatic LVDD group, the plasma NT-proBNP level was significantly higher in the 1: 1 HFNEF group than that in the asymptomatic LVDD group. There was a significant correlation between the plasma NT-proBNP level and the peak value of the left ventricular early diastolic longitudinal strain rate and the peak time of peak systolic strain in the left ventricular early diastolic phase. 2There was no significant difference in LVEF between HFNEF group and asymptomatic LVDD group. GLSRe02-LSRe03-LSRe04-LSRe04-LSRe03-LSRe03-LSRe04-LSRe04-LSRe03-LSRe03-LSRe03-LSRe03-LSRe03-LSRe04-LSRe04-LSRe04-L@@ (3) the Ts-SD of 16 segments and 12 segments of LVDD group was significantly longer than that of asymptomatic LVDD group. The difference was statistically significant (p 0.05). Ts-SDN Ts-diff was significantly correlated with the peak of global longitudinal strain and the peak value of global early diastolic longitudinal strain rate. Conclusion some of the indexes measured by 1. 2DSTI have a significant correlation with plasma NT-proBNP level. Strain and strain rate are good indexes to evaluate HFNEF. The evaluation of left ventricular systolic function by 2D STI in HFNEF patients was superior to that of LVEF. It could be found that the change of left ventricular systolic function was sensitive to the changes of diastolic function in early stage. It could be used to evaluate the degree of damage and to measure the synchronism of myocardial movement. To provide a new idea for the classification of diastolic dysfunction and the diagnosis and treatment of HFNEF.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R541.6

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相關期刊論文 前2條

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