应用二维斑点追踪技术评价中老年高钾血症患者左心室应变变化

Evaluation of left ventricular strain with two-dimensional speckle tracking technology in elderly patients with hyperkalemia

目的通过二维斑点追踪技术对中老年高钾血症患者左心室心肌应变能力的检测,评价临床治疗效果。方法选择内蒙古自治区人民医院慢性肾衰竭致高钾血症中老年患者24例,其中男性16例,女性8例;年龄55~79岁,平均年龄68.6岁。超声诊断心肌损害性改变。临床对症治疗前后,应用二维斑点追踪技术定量分析在治疗前后的左心室长轴纵向应变（LS）、径向应变（RS）、圆周应变（CS）,并与血钾、血肌酐进行相关性分析。结果超声表现为左心室壁弥漫性增厚17例（70.83%）,左心室壁回声增强22例（91.67%）,二尖瓣瓣器回声增强或见粗大光点11例（45.83%）,左心室内径增大1例（4.17%）,心包积液21例（87.50%）。入院治愈后,22例恢复正常,1例死亡,1例进展为扩张型心肌病。左心室长轴RS、LS、CS在治疗前后有显著提高（RS：8.97±1.27 vs 11.92±1.41;LS：14.96±2.41 vs 19.47±2.74;CS：9.68±1.59 vs 13.52±1.43）,差异有统计学意义（P〈0.05）。患者血钾、血肌酐的血样标本水平变化与心肌应变改善程度呈正相关（r=0.887,P〈0.01）。结论二维斑点追踪技术在中老年高钾血症患者心肌应变的诊断及治疗随访中具有一定的应用价值。

Objective To evaluate clinical therapeutic effect in application of two-dimensional speckle tracking echocardiog-raphy in elderly patients with hyperkalemia of left ventricular strain. Methods A total of 24 cases of elderly patients with hyperkalemia by chronic renal failure in the Inner Mongolia Autonomous Region People ＇s Hospital were enrolled, which included 16 males and 8 females, aged 55- 79 years old with mean age of 68.6 years old. The myocardial damage changes were di-agnosed by ultrasound. Before and after treatment, the radial strain（RS）, longitudinal strain（LS） and circumferential strain（CS）were analyzed by quantitative analysis of two-dimensional speckle tracking technology, and the serum potassium, serum creati-nine were correlation analyzed. Results There were ventricular septal and posterior left ventricular wall thickening in 17 cas-es（70.83 %）, left ventricular wall surface echo enhancement in 22 cases（91.67 %）, mitral valve echo enhancement in 11 cases（45.83 %）, left ventricular diameter enlargement in 1 case（4.17 %） and pericardial effusion in 21 cases（87.50 %）. After treat-ment, 22 cases recovered to normal, 1 death and 1 progressed dilated cardiomyopathy. Before treatment, RS was 8.97 ± 1.27,LS was 14.96 ± 2.41 and CS was 9.68 ± 1.59. After treatment, RS was 11.92 ± 1.41, LS was 19.47 ± 2.74 and CS was 13.52 ±1.43. The data were markedly increased after treatment, the difference was statistically significant（ P〈0.05）. There was positive correlated between serum potassium, serum creatinine changes and myocardial strain improvement（ r = 0.887, P〈0.01）.Conclusion It is demonstrated that two-dimensional speckle tracking has certain application value for diagnosis and treat-ment follow-up in myocardial strain of elderly patients with hyperkalemia.