【摘要】：目的: 應(yīng)用實時三維超聲心動圖(RT-3DE)容積-時間曲線(VTC)評價擴張型心肌病(DCM)患者心臟同步化（CRT）術(shù)后左心室舒張功能及舒張早期同步性變化以及二者間的關(guān)系；比較LBBB及NLBBB的CRT療效。 方法: 對39例DCM患者均于術(shù)前及術(shù)后1周、6個月、12個月行RT-3DE檢查,分析其VTC,得出左心室6節(jié)段、12節(jié)段、16節(jié)段舒張早期容積的時間標(biāo)準(zhǔn)差(Tedv-SD),用R-R間期標(biāo)準(zhǔn)化后,作為舒張早期不同步化指數(shù)(DDI)；得出左室收縮末容積（LVESV）、左室舒張末容積（LVEDV）、左室射血分?jǐn)?shù)（LVEF）；并計算出舒張期峰值充盈率（PFR）、舒張期早期容積與舒張末期容積之比(EDV早/EDV）；39例患者分為兩個亞組LBBB組（25例）和NLBBB組（14例），比較其CRT術(shù)后12個月的LVEF、LVEDV、DDI，及術(shù)前術(shù)后的差值ΔLVEF、ΔLVEDV、ΔDDI。 結(jié)果: ①與CRT術(shù)前比較，術(shù)后1周LVEDV、LVESV無明顯改善，而于術(shù)后6個月及12個月較術(shù)前改善有統(tǒng)計學(xué)意義(P＜0.05， P＜0.01)；LVEF術(shù)后1周、6個月及12個月與術(shù)前相比均有統(tǒng)計學(xué)意義（P＜0.05）。 ②各節(jié)段(T edv-SD)/R-R術(shù)后一周均較術(shù)前顯著縮短（P＜0.01），而術(shù)后1周、6個月及12個月之間差異均無統(tǒng)計學(xué)意義；PFR術(shù)后6個月增加有統(tǒng)計學(xué)意義（P0.05)，EDV早/EDV于術(shù)后12個月減少具有顯著統(tǒng)計學(xué)意義（P0.01)。 ③相關(guān)分析：CRT術(shù)前后ΔDDI與ΔEDV早/EDV減少呈顯著正相關(guān)（r=0.52，，P＜0.01），與ΔPFR呈負(fù)相關(guān)（r=-0.40，P＜0.05），ΔEDV早/EDV與ΔPFR之間也有良好的相關(guān)性（r=-0.56，P＜0.01）。 ④LBBB組較NLBBB組CRT術(shù)后LVEF增加有統(tǒng)計意義（P0.0001)；LVEDV明顯縮�。≒=0.020)；DDI明顯改善（P=0.036）；ΔLVEF、ΔLVEDV、ΔDDI兩組比較均有顯著統(tǒng)計學(xué)意義（P0.01）。 結(jié)論: ①DCM患者CRT術(shù)后左室同步性及心功能均得到改善，PFR、EDV早/EDV可作為評價左室舒張功能的有效指標(biāo) ②舒張早期的同步性改善會不斷的提高左室舒張功能。 ③DCM伴有LBBB患者行CRT術(shù)后獲益優(yōu)于伴NLBBB者。 ④RT-3DE VTC能直觀地顯示同步性及心肌運動幅度，可用于評價DCM患者CRT術(shù)前及術(shù)后的療效。
[Abstract]:Objective: to evaluate the left ventricular diastolic function and early diastolic synchronism after cardiac synchronization (CRT) in patients with dilated cardiomyopathy (DCM) by real-time three-dimensional echocardiography (RT-3DE) volume-time curve (VTC). To compare the effect of CRT between LBBB and NLBBB. Methods: RT-3DE was performed in 39 patients with DCM before operation, 1 week, 6 months and 12 months after DCM. VTCDE was analyzed. The time standard deviation (Tedv-SD) of left ventricular early diastolic volume (Tedv-SD) was obtained in 6 segments of left ventricle and 12 segments of left ventricle. After R-R interval standardization, the mean time standard deviation (Tedv-SD) of left ventricular early diastolic volume was obtained. The left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), peak diastolic filling ratio (PFR) and the ratio of early diastolic volume to end-diastolic volume (EDV) were calculated as early diastolic index (DDI), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF). 39 patients were divided into two subgroups: LBBB group (n = 25) and NLBBB group (n = 14). The differences of LVEF, 螖 LVEDVV, 螖 DDI were compared 12 months after CRT. Results: 1Compared with CRT before operation, LVEDVV / LVESV did not improve significantly at 1 week after operation, but it was significantly improved at 6 and 12 months after operation (P < 0.05, P < 0.01). At 1 week, 6 months and 12 months after LVEF, there was statistical significance (P < 0.05). 2 the postoperative week of each segment (T edv-SD) / R R was significantly shorter than that before operation (P < 0.01), but there was no significant difference between 1 week, 6 months and 12 months after LVEF (P < 0.05). The increase of PFR 6 months after operation was statistically significant (P0.05) that EDV decreased significantly at 12 months after operation (P0.01). 3 correlation analysis showed that there was a significant positive correlation between 螖 DDI and 螖 EDV early / EDV decrease before and after the operation (r = 0.52, P < 0.01), and a negative correlation with 螖 PFR (P < 0.01). There was also a good correlation between 螖 EDV and 螖 PFR (r-0.56, P < 0.01). 4 the LVEF in LBBB group was significantly higher than that in NLBBB group (P 0.0001). The decrease of LVEDV (P0. 020) and the improvement of DDI (P0. 036), and the difference of 螖 LVEF, 螖 LVEDVand 螖 DDI were statistically significant (P0.01). Conclusion: 1 left ventricular synchrony and cardiac function were improved after CRT in patients with DCM. Early EDV / EDV could be used as an effective index to evaluate left ventricular diastolic function. The benefits of CRT in 3DCM with LBBB were better than those with NLBBB. 4RT-3DE VTC could show the synchronism and the amplitude of myocardial movement directly. It can be used to evaluate the preoperative and postoperative effects of CRT in DCM patients.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R540.45;R654.2

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