瞬时波强和血管回声跟踪技术评估冠心病患者血流动力学的研究

Application of wave intensity and Echo-tracking technique to evaluate hemodynamics in patients with coronary heart disease

目的利用瞬时波强和血管回声技术评价冠心病患者的血流动力学变化及其临床意义。方法按冠脉造影冠状动脉病变累及程度将冠心病患者分为单支、2支、3支和左主干病变3个组,分别为A、B和C组,利用瞬时波强技术(WI),血管回声技术(ET)和常规超声对3组患者及正常对照组进行检测,各参数进行组间比较和相关性分析。结果 3组患者压力应变弹性系数(Ep)高于正常组,C组动脉顺应性(AC)低于A组和正常组,B组膨大系数(AI)高于其他3组,B组脉压(PP)高于正常组和C组,A组脉压高于正常组,3组患者颈动脉内中膜厚度(IMT)均增加且增厚程度与冠脉病变程度一致。B、C组W1下降,C组W2下降。相关性分析中,W1和W2、颈动脉血流最大速度(Umax)、硬度指数(β)、压力应变弹性系数、单点脉搏波传导速度(PWVβ)显著正相关,与膨大系数负相关,W2和负向波面积(NA)、脉压正相关,NA、硬度指数和脉压正相关。结论瞬时波强和血管回声跟踪是一种有效、无创和简便的评估冠心病患者血流动力学变化的超声技术,具有重要的临床应用意义。

Objective To evaluate the change of hemodynamics and its clinical significance in patients of coronary heart disease（CHD） with wave intensity and Echo-tracking technique.Methods 101 coronary heart diseasepatients and 40 healthy people were examined by wave intensity（WI）,Echo-tracking（ET）,conventional echocardiography and carotid ultrasonography technique,the CHD patients were classified into three groups,group A,B and C,according to severity of coronary stenosis by coronary angiography（CAG）,the parameters of these groups were made comparison and linear correlation analysis.Results Compared with the normal group the elasticity modulus（Ep） increased in CHD patients,Artery compliance decreased in group C comparing group A and normal group,Augmentation index（AI） became higher in group B than other groups,pulse pressure（PP） increased in group B compared with normal and group C subjects while also increased in group A.The intima media thickness increased in three patients group and paralleled with the severity of coronary stenosis.W1 in B and C group decreased,W2 in C group decreased.In correlation analysis,W1 has significant positive relationship with W2,stiffness parameter（β）,Ep and one-point pulse wave velocity while having negative relationship with AI;W2 corrlated positively with NA,PP;NA and β also have positive relationship with PP.Conclusion wave intensity and Echo-tracking are effective noninvasive and simple ultrasonic techniques to evaluate the changes of hemodynamics in patients with coronary atherosclerotic heart disease which has clinical application value.