超声心动图评价正常心脏结构与功能

Identification normal value of cardiac structure and function with echocardiography

目的 应用超声心动图测量正常人心脏大小，应用彩色多普勒超声测量各瓣口流速，以确定中国人心脏结构正常值以及心功能指标正常范围。方法对8302例正常人分别取胸骨旁长轴观测量左房、左室、右室、主动脉瓣环、主动脉窦及升主动脉内径，室间隔、左室后壁厚度。大动脉短轴观测量肺动脉干、左右肺动脉内径及肺动脉瓣峰值速度。心尖五腔观测量主动脉瓣峰值速度。心尖四腔观测量二尖瓣舒张早期峰值速度及舒张晚期峰值速度，三尖瓣舒张早期峰值速度及舒张晚期峰值速度。左室短轴观测量左室舒张末容积、收缩末容积，计算每搏量、左室短轴缩短分数及左室射血分数。以10岁为一年龄段计算各年龄段各项指标均数，按心脏结构各项指标对年龄进行聚类分析；按心功能各项指标对年龄进行聚类分析。并计算聚类后各年龄组各项指标95％可信区间作为正常值。结果按心脏结构各项指标对年龄进行聚类分析，分为3类即≤10岁，11～30岁，31～90岁。按左室收缩功能各项指标对年龄进行聚类分析，分为2类即≤10岁，11～90岁。按左室舒张功能各项指标对年龄进行聚类分析，分为3类即≤10岁，11～50岁，51～90岁。左室舒张功能与年龄呈负相关。结论中国人心脏发育分为3个阶段，30岁以后心脏结构固定。左室收缩功能在10岁以后呈稳定状态。左室舒张功能随年龄增长呈生理性减低。

Objective To identify normal value of cardiac structure and left ventricular（LV） function in normal subjects by ecbocardiograpby. Methods Cardiac structure, cardiac valve flow velocities and left ventricular function were detected in 8302 normal volunteers. The transmitral and transtricuspid peak rapid filling velocity （E）, peak atrial filling velocity （A）, and E/A were measured. The aortic valve and pulmonary valve peak systolic flow velocities were recorded. At the same time, distance of left atrium, LV, right ventricular, aorta, pulmonary artery, inter ventricular septal and post wall were measured. End diastolic volume, end-systolic volume, stroke volume, fractional shortening and ejection fraction were also calculated. Subjects were classified based on cardiac structure or LV function. And normal value was identified relying on 95 % confidence interval of variables. Results There were three groups： ≤10 year, 11-30 year, 〉30 year, based on cardiac structure. Normal subjects were also classified into two groups ≤10 year and 〉10 year） or three groups （≤10 year, 11 - 50 year, 〉50 year）, based on LV systolic function or diastolic function. And there was negative relationship between LV diastolic function and age. Conclusions There are three phases in cardiac structure growth of Chinese. After 30 years old, cardiac structure is stable. LV systolic function is stable after 10 years old. However, LV diastolic function is physical decreased with increasing age.