二维应变技术评估藏区动脉导管未闭患儿介入治疗后左心室心肌收缩功能

Using Two-dimension Strain and Strain Rate to Evaluate the Function of Left Ventricular Myocardial Systole about Tibetan Children after Interventional Therapy

目的应用二维应变及应变率成像技术评估高海拔缺氧地区(平均海拔3500 m以上)动脉导管未闭患儿介入封堵前后左心室局部心肌收缩功能的变化。方法将我院收治的3批次来自藏区高原缺氧地区先天性心脏病动脉导管未闭(Patent Ductus Arteriosus,PDA)的31例患儿作为藏区组,于术前1 d及术后7 d在血流动力稳态情况下行超声心动图检查。同时,选择年龄、性别相匹配的同期因其他疾病在我院住院接受治疗或正常查体的儿童共25例做为正常对照组,进行超声心动图检查,分别连续采集3个以上心动周期,图像导入Echo PAC超声工作站,人工将左心室游离壁及室间隔各划分为3个节段,测量节段心肌的收缩功能,并进行统计学分析。结果藏区组术后左心室舒张末径(LVEDd)及左心室舒张末期容积(LVEDV)减小,左心室射血分数(EF)减低;左心室每搏输出量(SV)、左心室舒张末期容积指数(LVEDVI)降低。术后与术前比较,左室游离壁基底段、中间段、心尖段及室间隔中间段应变均下降。室间隔基底段及心尖段应变较术前增加。术后与术前应变率比较左室游离壁基底段、中间段、心尖段及室间隔中间段应变率均减低,与应变曲线走形相一致,室间隔基底段及心尖段应变率较术前无统计学差异。藏区组术前左室游离壁3个节段及室间隔中间段应变高于对照组;室间隔基底段及心尖段应变低于对照组。而术后左室游离壁3个节段及室间隔3个节段与对照组无统计学差异。结论二维应变技术可无创、定量评估动脉导管未闭介入治疗前后左心室心肌的收缩功能,且较EF值对心肌收缩功能变化的定量评估更加敏感。

Objective To study the function of left ventricular about patent ductus arteriosus Tibetan children after interventional closure with two-dimension sWain and sWain rate imaging technique. Methods The sample consisted of 31 PDA children （11 boys and 20 girls） in Tibetan district. Their average age is 8.52-3.00years, and make the TEE in a stable condition one day before and seven days after the closure. We chose the other 25 children with the same age and sex cured in our hospital for other diseases for control group. Take more than three continuous cardiac cycle and induce them into Echo PAC then get the curve of systole peak strain and strain rate. Results There is no difference in the age, sex, weight, blood pressure, heart rate between Tibetan group and control group. The height of the children in Tibetan group is lower than control group.The changes in the left ventricle function standard of the children after closure is LVEDd and LVEDV decreased remarkably seven days after the closure. There is no obvious statistic difference in LV EELVSV and LVEDVI decreased and has statistic difference. The strain of Tibetan children is basal, middle, and apical segments of left ventricular full wall and middle interventricular septum decreased after the closure.. Basal and apical ventricular septal increased. The strain rate of left ventricular full wall and middle segments of septal decreased after the closure. The strain of left ventricular full wall and middle interventricular septum in Tibetan group is higher than control group in pre--closure, basal and apical ventricular septal is lower than control group.There is no difference in left ventricular full wall and ventricular septal in post-closure. Conclusion Two-dimensional technique could evaluate the systolic about local heart muscale of Tibetan children who has PDA, the effect is better than the value of EF.Tibetan children left ventticular myocardial systole recovery shortly after closure.