实时三维超声估测心室搏出量的实验研究

Quantify ventricular stroke volume in vivo using real-time three-dimensional echocardiography

目的评价实时三维超声心动图(RT-3DE)估测心室搏出量的可行性和准确性。方法以Swan-Ganz导管热稀释法测定的心室搏出量为标准,应用Philips RT-3DE系统采集10头健康猪心“金字塔形”数据库,结合TomTec4D Cardio-View RT测量软件用心尖长轴8平面法测量左、右室舒张末期和收缩末期容量,计算左、右室搏出量,并与二维超声双平面Si mpson法测值比较。结果所有猪心均获满意的左、右室RT-3DE显示,其形态与直视下猪心心室实际形态相似。其中,RT-3DE8平面法估测左室搏出量[(24.58±3.44)ml]与其右室搏出量[(23.58±3.18)ml]呈高度相关(r=0.93),并与Swan-Ganz导管热稀释法测值[(25.64±3.18)ml]有良好相关性(r=0.85,r=0.92)。经方差分析、SNK均数间两两比较检验,三者间差异无统计学意义(P>0.05)。而二维超声双平面Si mpson法估测左室搏出量[(16.83±4.71)ml]与其右室搏出量[(10.10±2.87)ml]与Swan-Ganz导管热稀释法测值仅呈低度相关(r=0.59,r=0.39),尤以右室搏出量低估程度较明显,且其左、右室搏出量间相关性较低(r=0.76)。经方差分析、SNK检验,三者间差异有统计学意义(P<0.05)。结论RT-3DE是估测心室搏出量的可靠手段。

Objective To evaluate the feasibility and accuracy of real-time three-dimensional echocardiography （RT-3DE） in quantifying ventricular stroke volume in an in vivo experimental study. Methods Ten porcine hearts were examined by RT-3DE and conventional two-dimensional echocardiography （2DE） with Philips Sonos 7500 ultrasound system. The left and right ventricular stoke volume examined by RT-3DE was outlined and calculated by 8-plane method with the 4D Cardio-View RT of TomTec image system, and the results were compared with those of 2DE biplane Simpson-method. The values of ventricular stroke volume measured by Swan-Ganz pulmonary thermodilution method were served as reference values. Results ＂Full volume＂ imaging in all porcine hearts was well displayed by RT-3DE. The ventricular shapes displayed by RT-3DE were similar to the anatomic ventricular shapes. From the findings of analysis of variance and Student-Newman-Keuls test, there was no significant difference （P 〉 0.05） between the left ventricular stroke volume with RT-3DE [-（24.58±3.44） ml], the right ventricular stroke volume with RT-3DE [-（23.58±3.18）ml] and those values measured with Swan-Ganz pulmonary thermodilution method [-（25.64±3.18）ml]. Furthermore, there was well correlation between the left ventricular stroke volume and the right ventricular stroke volume with RT-3DE （r = 0.93）. They were also well correlated with those values with Swan-Ganz pulmonary thermodilution method （r = 0.85, r = 0.92）. However, there was significant difference （P 〈 0.05） between the left ventricular stroke volume with 2DE [-（16.83±4.71）ml], the right ventricular stroke volume with 2DE [（10.10±2.87）ml] and those values with Swan-Ganz pulmonary thermodilution method. Moreover, the right ventricular stroke volume with 2DE was underestimated more than the left ventricular stroke volume with 2DE. There was poor correlation between them （r = 0.76）. They were also poorly correlated with those values measured with Swan-Ganz pulmonary thermodilution method （r = 0.59, r = 0.39）. Conclusions RT-3DE is a valuable and accurate technique to quantify ventricular stroke volume.