斑点追踪技术评价急性肺栓塞患者右心室局部收缩功能的临床研究

Evaluation of the right ventricular regional systolic function in patients with acute pulmonary embolism by two dimensional speckle tracking imaging

目的观察急性肺栓塞（acutepulmonaryembolism，APE）患者抗凝、溶栓治疗前后右室心肌应变、应变达峰时间的特点，探讨二维斑点追踪技术在APE患者疗效评价中的价值。方法急性肺栓塞患者25例，正常对照组30例为研究对象，应用二维斑点追踪技术测量并记录右室侧壁及室间隔的基底段、中间段、心尖段心肌纵向收缩峰值应变（PSS）和应变达峰时间（sT），并计算达峰时间均数（ST。）和标准差（STsU）。结果①APE患者治疗前右室侧壁及室间隔各节段PSS减低（P〈O．05）。②APE治疗后右室侧壁及室间隔各节段PSS高于治疗前（P〈O．05）；治疗后心尖段PSS与对照组比较差异无统计学意义（P〉0．05），其他各节段PSS低于对照组（P〈0．05）。③APE治疗前后STSD增高（P〈O．05）。结论APE患者右室心肌各节段PSS减低，心肌应变达峰时间标准差增大；APE治疗后心肌应变有所恢复，但仍减低。二维斑点追踪技术可客观评价APE患者治疗后疗效。

Objective To observe changes of the right ventricular （RV） myocardial strain and the time to peak strain （ST） before and after anticoagulant and thrombolytic therapy in patients with acute pulmonary embolism （APE） by two dimension speckle tracking imaging （2D-STI）. Methods A total of 25 patients with APE along with 30 age-matched and gender-matched normal subjects （as control group） were examined by echocardiography. And basal, mid, apical segments of right ventricular wall and septum（6- segments） longitudinal peak systolic strain （PSS） and the time to peak strain （ST） were analyzed by 2D~ STI. The mean and standard deviation （STsD） of 6-segmental ST were calculated. Results O Compared with control group cases, PSS of 6-segments were significantly impaired in patients with APE （ P 〈0. 05）. OThe PSS of 6-segments in APE patients after treatment were significantly higher than that of before treatment （ P 〈0.05）. The PSS of apical segment of the right ventricular wall and interventricular septum in APE patients after treatment showed no significant difference with the control group （ P 〈0.05）. The PSS of other segments in APE patients were significantly lower than that of control group （all P 〈0.05）. （3） The STsD of APE patients before and after treatment were significantly higher than that of the control group （ P 〈0.05）. Conclusions The PSS of 6-segments of RV were decreased in patients with APE and STsD were increased. After treatment, the PSS of APE patients were returned. However, the PSS in APE patients were not returned to normal. Two-dimension STI can objectively assess the curative effect of APE patients after treatment.