PW与PW-DTI成像技术在尿毒症患者左室舒张功能评价中的应用价值

Application value of PW and PW- DT in the assessment of left ventricular diastolic function among patients with uremia

目的探讨脉冲多普勒法(PW)与脉冲多普勒组织成像(PW-DTI)技术在评价尿毒症患者左心室舒张功能中的价值。方法对130例尿毒症患者分别采用脉冲波多普勒法(PW)测量二尖瓣口前向血流速度参数:舒张早期峰值速度(E)、舒张晚期峰值速度(A),计算E/A比值;采用PW-DTI技术测量左室侧壁、前壁、下壁、室间隔的二尖瓣环水平DTI参数:舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),计算Em/Am比值;对比分析两种检测方法。结果 PW-DTI对尿毒症患者左心室舒张功能异常检出率为86.15%,明显高于PW的60.0%,其差异有统计学意义(χ2=22.59,P<0.01)。结论 PW-DTI技术可以实时定量地反映心肌运动的方向与速度,客观评价左心室舒张功能,有效避免频谱多普勒检查存在的假性正常化现象。

Objective To explore the value of pulsed wave Doppler （PW） and pulsed wave Doppler thue imaging （PW- DTI） in the evaluation of left ventricular diastolic function in uremia patients. Methods One hundred and thirty patients with uremia were selected for the study. PW was used to measure the indexes of mitral valve flow pattern as early diastolic flow veloci ty （E） and late diastolic peak velocity （A）, and the E/A ratio was calculated. Then PW DTI was used to measure early diastol- ic motion velocity （Em） and late diastolic motion velocity （Am） of the four sites of the mitral annular. The four sites included the lateral wall, the anterior wall, the inferior wall and ventricular septum. Furthermore, the ErrdAm ratio was calculated, and the two measurements were compared and analyzed. Results Using PW, 60.0 % abnormal cases of E/A value were detected, while 86.15 % abnormal cases of ErrdAm value were detected by using PW DTI, which was significantly higher than that of PW. The differences of detection rates of abnormal cases between these two measure ways had statistically significant （ χ2= 22.59, P〈0.01）. Conclusions PW- DTI could be used to evaluate the direction and velocity of myoeardium movement quantitatively and accurately, and provide an objective assessment of left ventrieular diastolic function which could avoid pseudo normal in PW.