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應(yīng)用組織多普勒技術(shù)評價房間隔缺損微創(chuàng)封堵術(shù)右心室室壁運動變化

Tissue Doppler Technique Used for the Evaluation of the Right Ventricular Wall Movement in the Intraoperative Device Closure of Atrial Septal Defects

作者: 張麗華  米彥軍  王巖  劉愛琴  封淑文  黃建新 
單位:武警北京總隊第二醫(yī)院 (北京 100037)
關(guān)鍵詞: 組織多普勒;右心室室壁運動;房間隔缺損;微創(chuàng)外科封堵;評價   
分類號:
出版年·卷·期(頁碼):2011·30·6(635-637)
摘要:

目的 通過應(yīng)用組織多普勒技術(shù)監(jiān)測微創(chuàng)外科房間隔缺損封堵術(shù)前后右心室室壁的運動變化并結(jié)合相應(yīng)的功能評價,探討組織多普勒技術(shù)在微創(chuàng)外科房間隔缺損封堵術(shù)中的應(yīng)用價值。方法 分別于術(shù)前及術(shù)后3~5d對65例選擇進(jìn)行微創(chuàng)外科繼發(fā)孔房間隔缺損封堵術(shù)治療的患者進(jìn)行經(jīng)胸超聲心動圖檢查,應(yīng)用組織多普勒頻譜圖測量右室側(cè)壁基底部(三尖瓣環(huán)處)、中間部以及室間隔基底部(三尖瓣環(huán)處)、中間部的室壁分別在收縮期、舒張早期和舒張晚期的峰值速度,并應(yīng)用組織多普勒M型技術(shù)對左室長軸切面室間隔中部的運動變化情況進(jìn)行封堵前后對照比較。結(jié)果 與術(shù)前比較,術(shù)后右室側(cè)壁及室間隔的收縮期室壁運動峰值速度(s′)、舒張晚期組織運動峰值速度(a′)均顯著減低(P<0.01);右室側(cè)壁及室間隔中間部舒張早期運動峰值速度(e′)也較術(shù)前明顯減低(P<0.01);術(shù)后所有患者室間隔中部與左室后壁的同向運動現(xiàn)象均得到明顯改善或消失。結(jié)論  組織多普勒技術(shù)能夠準(zhǔn)確評價微創(chuàng)外科房間隔缺損封堵術(shù)后右室壁的運動變化,可為臨床評價手術(shù)效果提供參考。

Objective To evaluate the clinical value of tissue Doppler in minimal-invasive surgical device closure of atrial septal defects, the tissue Doppler was utilized for measuring the movement of right ventricular wall. Methods Echocardiography tests were performed before operation and 3 to 5 days after the operation while 65 patients with secundum atrial septal defects underwent minimal-invasive surgical device closure. The tissue Doppler velocity spectra were detected to measure the movement of tricuspid annulus and middle part of right ventricle. Systolic peak velocity(s′), early diastolic peak velocity (e′) and late diastolic peak velocity (a′) of tricuspid annulus and middle part of right ventricle were analyzed, and M mode tissue Doppler of interventricular septum and left ventricular posterior wall were analyzed as well. Results Compared with the preoperation values, the after operation values of the systolic peak velocity(s′) and late diastolic peak velocity (a′) of tricuspid annulus decreased significantly (P<0.01),and early diastolic peak velocity (e′) of right ventricle also decreased significantly (P<0.01). And the abnormal motion of interventricular septum was improved after the closure of atrial septal defects. Conclusions Tissue Doppler is supposed as a tool in evaluating the changes of right ventricular motion in minimal-invasive surgical device closure of secundum atrial septal defects.

參考文獻(xiàn):

[1]Figueroa MI, Balaguru D, McClure C, et al. Experience with use of multiplance  transesophageal echocardiography to guide closure of atrial septal defects using the amplatzer device[J]. Pediatr Cardiol , 2002,23:430-436.
[2]盧旺盛,田增民.機(jī)器人在外科領(lǐng)域應(yīng)用現(xiàn)狀[J].北京生物醫(yī)學(xué)工程,2010,29(1):101-105.
[3]Otani H , Kagaya Y, Yamane Y, et al. Long-term right ventricular volume overload increases myocardial fluorideoxy glucose uptake in the interventricul arseptum in patients with atrial septal defect[J] . Circulation, 2000,101(14):1686-1692.
[4]張妍,王珂,劉曉萍,等. 房間隔缺損封堵術(shù)后右心形態(tài)和功能變化的隨訪觀察[J]. 中國循環(huán)雜志, 2002,17(4):290-291.
[5]田英軍,張軍,姚志勇, 等. 組織多普勒成像在房間隔缺損封堵術(shù)中的應(yīng)用[J]. 武警醫(yī)學(xué),2008,19(7):585-587.

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