多普勒联合超声评价心房颤动复律后心房顿抑的临床研究

Clinical study of the atrial stunning after cardioversion of atrial fibrillation with tissue Doppler and ultrasound

目的 应用心肌组织多普勒成像（TDI）技术结合M型超声、脉冲多普勒及心尖搏动图测定二尖瓣环运动速度及幅度、跨二尖瓣血流速度及压力变化,评价心房颤动复律后心房顿抑的发生.方法 38例心房颤动患者于复律后1 h行超声检查.采用TDI技术测量二尖瓣环游离壁舒张晚期心肌组织运动峰速（Am）、舒张早期心肌组织运动峰速（Em）,M型超声测量二尖瓣环游离壁舒张晚期心肌最大运动幅度（DAD）、舒张早期心肌最大运动幅度（DED）,脉冲多普勒测量舒张早期跨二尖瓣血流速度（E）和舒张晚期跨二尖瓣血流速度（A）,心尖搏动网记录心房收缩压力波.根据有无心房顿抑分为顿抑组和非顿抑组.结果 复律后1 h,11例患者发生心房顿抑.复律方式两组比较差异无统计学意义（P〉0.05）;顿抑组复律前心房颤动持续时间及左房内径与非顿抑组比较差异有统计学意义（P〈0.05）.心房收缩期A、Am及DAD值顿抑组均为0,非顿抑组分别为（43±34）cm/s、（6±4）cm/s、（0.27 ±0.18）cm,两组比较差异均有统计学意义（P〈0.05）.结论 心房颤动复律后有心房顿抑发生.左房内径越大、心房颤动持续时间越长,越容易发生心房顿抑.

Objective To evaluate atrial stunning after successful cardioversion in patients with atrial fibrillation by utilizing tissue Doppler imaging（TDI）,M-mode echocardiography in left atria-ventricuhr annulus motion,together with pulsed Doppler echocardiography and apexcardiogram.Methods Thirtyeight patients with atrial fibrillation who in 1 hour after successfully underwent electrical or pharmacological cardioversion were involved.The peak motion velocity of mitral annulus during atrial contraction period（Am）and peak motion velocity during early diastolic period（Em） was detected by TDI.The biggest motion argument of mitral annulus during atrial contraction period（DAD）and biggest motion argument during early diastolic period（DED）was detected byM-mode echocardiography.The blood flow velocity of mitral during early diastole（E）and atrial contraction（A） was also measured by pulsed Dopphr echocardiography and pressure wave during atrial systole was recorded by apexcardiogram.The patients were divided into two groups according to whether they had atrial stunning（atrial stunning group and non-atrial stunning group）.Results The incidence of atrial stunning occurred in left atrium was 28.9%（11/38）at 1 hour after successful cardioversion.There was no significant difference in cardioversion method between two groups（P〉0.05）.The patients in atrial stunning group had longer duration of atrial fibrillation and Larger left atrium（P〈0.05）.A,Am and DAD in the atrial systole period in atrial stunning group was 0.but in non-atrial stunning group was（43±34）cm/s,（6±4）cm/s,（0.27 ±0.18）cm,respectively,and there were significant difference between two groups（P〈0.05）.Conclusion Atrial stunning can happen in left atrium after successful cardioversion,and atrial stunning is related to the duration of atrial fibrillation and the dimension of left atrium.