实时三维超声对风湿性二尖瓣狭窄患者右心功能的评估

Assessment of right ventricular function in rheumatic mitral stenosis using transthoracic real-time three-dimensional echocardiography

目的应用实时三维超声心动图（RT-3DE）对风湿性二尖瓣狭窄（RMS）右心功能进行定量评估。方法完全随机选择RMS患者46例为试验组，其中轻度狭窄患者（轻度组）16例、中度狭窄患者（中度组）13例、重度狭窄患者（重度组）17例；选择与其年龄相匹配，基础心律为窦性心律，经体检心电图和常规超声心动图诊断正常的16名健康成人为对照组。应用RT-3DE测量其右心室舒张末期容积（RVEDV）、右心室收缩末期容积（RVESV）并计算出右心室射血分数（RVEF）。结果RMS轻度组RVEDV值与正常组比较差异无统计学意义[（72．79±22．70）％比（57．60±11．44）％，P〉0．05]，RVESV值较正常组增大[（34．49±14．16）％比（22．83±4．80）％，P〈0．05]，RVEF值较正常组下降[（53．09±6．39）％比（60．21±5．08）％，P〈0．01]；RMS中度组RVEDV、RVESV、RVEF值[（77．17±26．04）％、（39．52±17．42）％、（50．03±6．76）％]与正常组比较差异均有统计学意义（P〈0．05或P〈0．01）；RMS重度组RVEDV、RVESV、RVEF值[（88．40±24．75）％、（49．01±19．57）％、（46．25±7．16）％]与正常组比较差异均有统计学意义（P均〈0．01），重度组RVEDV、RVEF值与轻度组比较差异均有统计学意义（P〈0．05或P〈0．01）。其他各组间比较差异均无统计学意义（P〉0．05）。结论RMS患者右心功能受损早于左心功能，右心室容量（尤其是中度、重度狭窄患者）较正常人显著增加，右心功能明显下降；RT-3DE能准确评价其右心功能。

Objective To evaluate right ventricular （RV） volume and function in patients with rheumatic mitral stenosis （RMS） by real-time three-dimensional echocardiography （RT-3DE）. Methods Forty-six patients of RMS with mild （n = 16）, moderate （n = 13） and severe （n = 17） stenosis were examined by RT-3DE. Sixteen age-matched healthy adults in sinus rhythm with normal electrocardiogram and routine echocardiogram were enrolled as controls. The right ventricular end-diastolic volume （RVEDV） and fight ventricular end-systolic volume （RVESV） were measured and the right ventricular ejection fraction （RVEF） was calculated. Results There was no significant differences of RVEDV between mild stenosis patients and healthy controls （P 〉 0.05 ） , but there were significant differences among patients with moderate （ P 〈 0.05 ） and severe （ P 〈0. 01 ） stenosis and healthy controls. RVESV of patients with mild or moderate （P 〈 0.05） or severe （P 〈 0.01 ） stenosis was significantly greater than that of controls. RVEF was significantly lower in all the patients that in with healthy controls （ P 〈 0.01 ）. Furthermore, RVEDV of patients with severe stenosis was significantly greater than that of mild stenosis （ P 〈 0.05 ）. There was a significant difference of RVEF between patients with mild and severe stenosis （ P 〈 0.01 ）. Conclusions RV function is impaired earlier than LV function in patients with RMS. Patients with moderate or severe stenosis have a higher RV volume and lower RV function than healthy persons. RT-3DE can accurately evaluate RV function.