组织同步显像对维持性血液透析患者左心室收缩非同步性研究

Evaluation of the left ventricular systolic asynchrony in hemodialysis depended patients by tissue synchronization imaging

目的探讨组织同步显像（TSI）评价维持性血液透析（血透）患者左室收缩非同步性的价值。方法70例维持性血透患者分为两组，其中：血透1组为左室内径增大组，左室舒张末内径（LVDd）〉55mm，35例；血透2组为左室内径正常组，LVDd≤50mm，35例。35例正常成年人为对照组。应用TSI测量各节段达峰时间（T，经心率校正后为Tc）和收缩期峰值速度（PSV）。结果①血透组平均Tc延迟（P〈0．01），绝大部分节段Tc较对照组延迟，差异均有统计学意义（P〈0．05）；②血透组共463（463／840）节段表现为黄色或红色的达峰时间延迟，心肌节段收缩延迟在血透组发生率为100％（70／70）；③血透组平均PSV和绝大部分节段PSV小于对照组（P〈0．05）；④与血透2组比较，血透1组部分节段的Tc延长，PSV下降（P〈0．05），而平均Tc、平均PSV差异无统计学意义（P〉0．05）。结论TSI可发现维持性血透患者左心室收缩非协调性，为临床综合治疗提供理论依据。

Objective To evaluate the left ventricular systolic synchrony in hemodialysis depended（HD） patients by tissue synchronization imaging（TSI）. Methods GE Vivid 7 ultrasound system with TSI and Q-analyze software was performed in 70 HD patients and 35 control individuals. According to the left ventricular enddiastolic diameter（LVDd）, HD patients were divided into left ventricular enlarged group （HD1, LVDd〉55 mm） and non-left ventricular enlarged group （HD2, LVDd≤50 mm）. Systolic asynchrony was determined by measuring the time to peak systolic velocity of all 12 segments corrected by the heart rate （Tc）. Results ①The mean Tc and the Tc of most segments were greater in both the HD1 and HD2 groups than in controls （both P 〈0.05）. ②The Tc was prolonged in 463（463/840） segments in HD group and left ventricular systolic asynchrony was detected in all patients （70/70）. ③The mean peak systolic velocity （PSV） and the PSV of most segments in HD group were lower than those in the control group （ P 〈0.05）. ④Compared with HD2 group,Tc was increased and PSV was decreased in partial segments of HD1 group （ P〈0.05） ,but no significant differences in mean Tc and mean PSV were found between HD1 and HD2 groups （ P 〉0.05）. Conclusions Left ventricular systolic synchronicity was impaired in hemodialysis depended patients. TSI was shown to be useful for the detection of myocardial abnormalities and asynchrony in such patients and provided reliable parameters for clinical therapy.