二尖瓣置换术患者左心室整体及局部节段心肌收缩功能的初步定量化研究

Assessment of the whole and local systolic function in left ventricular of the patients undergoing mitral valve replacement

目的应用经食管超声心动图(TEE)的常规技术和组织多普勒超声心动图(TDE)技术评价二尖瓣置换术(MVR)患者心肺转流(CPB)前后左心室整体与局部心肌的收缩功能。方法择期CPB下行MVR的患者20例,ASAⅡ或Ⅲ级,心功能NYHA分级2或3级,EF≥45%。于麻醉诱导后锯胸骨前(T0)和停CPB后30min(T2)、90min(T2)时采用TEE常规技术和TDE技术,记录患者左心室射血分数(LVEF)和左室前、后壁等容收缩期速度平均值(Sm1)和射血期速度平均值(Sm2)等。结果 T0、T2时,Sm1明显大于Sm2(P<0.01或P<0.05);而T1时Sm1与Sm2差异无统计学意义。结论通过TDE技术评价二尖瓣置换术患者CPB后早期左心室整体及局部心肌收缩功能,并未明显受损害,但是等容收缩期心肌运动速度大于射血期。

Objective To evaluate the whole and local myocardial systolic function of the left ventricular before and after cardiopulmonary bypass（CPB）by conventional technology of transesophageal echocardiography（TEE）and tissue Doppler echocardiography（TDE）during mitral value replacement（MVR）.Methods Twenty patients with ASA ⅡorⅢgrade,NYHA class 2or 3and EF≥45%,scheduled for mitral value replacement with cardiopulmonary bypass were studied.The cardiac systolic parameters were determined at three periods using routine TEE and TDE technology following MVR：after anesthesia induction and before sternotomy（T0）,30 minutes after cessation of bypass（T1）,90 minutes after cessation of bypass（T2）.Recording in patients with the left ventricular ejection fraction（LVEF）and the average velocity of anterior and posterior wall of left ventricle in isovolumetric contraction（Sm1）and ejection period（Sm2）.Results At T0 and T2,Sm1 significantly greater than Sm2（P〈0.01 or P〈0.05）.Between the two groups,there was no statistical significance at T1.Conclusion The whole and local myocardial systolic function of the early left ventricular has not been obviously damaged after CPB by TDE technology evaluation of mitral value replacement patients,but the velocity of myocardial motion during isovolumic contraction is larger than that of the ejection period.