实时三平面超声心动图对围手术期风湿性心瓣膜病右心室功能的临床研究

Clinical study on perioperative right ventricular function for patients with rheumatic heart disease using real-time triplane echocardiography

目的应用实时三平面超声心动图评价围手术期风湿性心瓣膜病患者右心室整体功能的改变状况。方法检测18例二尖瓣置换术联合三尖瓣置换术或三尖瓣成形术患者（观察组）和15例单纯行二尖瓣置换术患者（对照组）的围手术期心脏常规各项超声指标，同时应用实时三平面超声心动图获得右心室的容积和收缩功能指标。结果①术前观察组和对照组各项超声测值差异无统计学意义（P〉0．05）。②术后观察组和对照组比较。左房大小差异无统计学意义，右房室大小、肺动脉内径、肺动脉收缩压、右室舒张末容积、右室收缩末容积、右室射血分数值差异有统计学意义（P〈0．05）。③右室射血分数与右室内径呈负相关性（r=-0．37，P〈0．05），与肺动脉压呈正相关（r=0．45。P〈0．05）。结论实时三平面超声心动图可快速、准确观测风湿性心瓣膜病患者围术期的右室容积及功能变化，为临床无创性评估右心室功能以及指导治疗提供了有力手段。

Objective To evaluate the changes of perioperative right ventricular volume and function of patients with rheumatic heart disease using real-time tri-plane echocardiography（RT-TPE）. Methods A total of 33 rheumatic heart disease patients with tricuspid insufficiency were classified into study group[18 cases,mitral valve relacement（MVR） ＋ tricuspid valve replacement or tricuspid valve plasty] and control group（15 cases, MVR only）, pre- and post-operative two dimensional and RT-TPE were performed on both groups. Results ① There was not significant difference on echocardiographic indexes between the two groups preoperatively（ P 〉0. 05）. ② After operation,left atrium diameter was not significantly different between the two groups （ P 〉0.05）. Right ventricular diameter, right atrial diameter, pulmonary artery systolic pressure（PASP）, right ventricular enddiastolic volume（RVEDV）, right ventricular end-systolic volume（RVESV）, right ventricular ejection fraction （RVEF） were significantly different between the two groups（ P 〈0.05）. ③ RVEF was negatively correlated with right ventricular diameter （ r = - 0.37, P 〈0.05） and positively with PASP（ r = 0.45, P 〈0.05）. Conclusions RT-TPE provides a fast,convenient,non-invasive technique to evaluate perioperative right ventricular volume and function of patients with rheumatic heart disease.